Sue’s acquisition of stereoscopy after almost half a century of being stereo-blind has also been of great practical benefit. Driving is easier; threading a needle, too. When she looks down into her binocular microscope at work, she can see paramecia swimming at different levels, and see this directly, rather than inferring it by refocusing the microscope up or down. And it is a continuing source of enthrallment:
At seminars . . . my attention is completely captivated by the way an empty chair displays itself in space, and a whole row of empty chairs occupies my attention for minutes. I would like to take a whole day just to walk around and LOOK. I did escape today for an hour to the college greenhouse just to look at the plants and flowers from all angles.
Most of the phone calls and letters I receive are about mishaps, problems, losses of various sorts. Sue’s letter, though, was a story not of loss and lamentation but of the sudden gaining of a new sense and sensibility and, with this, a sense of delight and jubilation. Yet her letter also sounded a note of bewilderment and reservation: she did not know of any experience or story like her own and was perplexed to find, in all she had read, that the achievement of stereoscopy in adult life was “impossible.” Had she always had binocular cells in her visual cortex, she wondered, just waiting for the right input? Was it possible that the critical period in early life was less critical than generally thought? What did I make of all this?
I mulled over Sue’s letter for a few days and discussed it with several colleagues, including Bob Wasserman, an ophthalmologist, and Ralph Siegel, a vision physiologist.10 A few weeks later, in February of 2005, the three of us went to see Sue at her home in Massachusetts, bringing along ophthalmological equipment and various stereoscopes and stereograms.
Sue welcomed us and, as we chatted, showed us some childhood photos, since we were interested in trying to reconstruct her early visual history. Her childhood strabismus, prior to surgery, was quite clear in the photographs. Had she ever been able to see in three dimensions? we asked. Sue thought for a moment and answered yes, perhaps—very occasionally, as a child, lying in the grass, she might suddenly see, for a second or two, a blade of grass stand out from its background; she had almost forgotten about this until we quizzed her. The grass would have to be very close to her eyes, within inches, requiring her (like any of us) to cross her eyes. So there was a suggestion that the potential for stereopsis was there and could be brought out if she moved her eyes into the proper position for stereo viewing.
Sue had written in her letter, “I think, all my life, I have desired to see things in greater depth, even before I knew I had poor depth perception.” This strange, poignant remark made me wonder whether she had retained some dim, barely conscious memory of having once seen things in greater depth (for she would have no sense of loss or nostalgia for something she had never had). It was important to test her with special stereograms that had no cues or clues as to depth—no perspective or occlusion, for example. I had brought one stereogram with lines of print—unrelated words and short phrases—that, if viewed stereoscopically, appeared to be on seven different planes of depth but, if viewed with one eye or without true stereo vision, appeared to be on the same plane. Sue looked at this picture through the stereoscope and saw it as a flat plane. It was only when I prompted her by telling her that some of the print was at different levels that she looked again and said, “Oh, now I see.” After this, she was able to distinguish all seven levels and put them in the correct order.
Given enough time, Sue might have been able to see all seven levels on her own, but such “top-down” factors—knowing or having an idea of what one should see—are crucial in many aspects of perception. A special attention, a special searching, may be necessary to reinforce a relatively weak physiological faculty. It seems likely that such factors are strongly operative with Sue, especially in this type of test situation. Her difficulties in real life are much less, because every other factor here—knowledge, context, and expectation no less than perspective, occlusion, and motion parallax—helps her experience the three-dimensional reality around her.
Sue was able to see depth in the red-and-green drawings I had brought. One of these images—an impossible three-pronged tuning fork such as M. C. Escher might have drawn, with three tines of increasing heights—Sue found “spectacular”; she saw the top of the uppermost prong as three or four centimeters above the plane of the paper. Yet Sue had spoken of herself as having only a “shallow” stereoscopy, and indeed, Bob and Ralph both saw the uppermost prong as about twelve centimeters above the plane of the paper, while I saw it as five centimeters higher still.
I found this surprising, because we were all the same distance from the drawing, and I had imagined that there would be, by a sort of neural trigonometry, a fixed relationship between the disparity of the images and their perceived depth. Puzzled by this, I wrote to Shinsuke Shimojo, at Caltech, an expert on many aspects of visual perception. He brought out, in his reply, that when one looks at a stereogram, the computational process in the brain is based not solely on the binocular cue of disparity but also on monocular cues such as size, occlusion, and motion parallax. The monocular cues may work against the binocular ones, and the brain must balance one set of cues against the other to arrive at a weighted average. This final result will be different in different individuals, because there is huge variation, even in the normal population: some people rely predominantly on binocular cues, others on monocular cues, and most use some combination of both. In looking at a stereo picture such as the tuning fork, a strongly binocular person will see unusual stereo depth; a monocularly oriented person will see much less depth; and others, relying on both binocular and monocular cues, will see something in between. Shimojo’s formulation gave substance to the obstinate belief held by many of us in the New York Stereoscopic Society that we lived in a “deeper” world, visually, than the majority of people.11
Later in the day, we paid a visit to Sue’s optometrist, Dr. Theresa Ruggiero, who described how Sue had first consulted her, in 2001. Sue had complained then of eyestrain, especially when driving, impaired clarity, and a disconcerting jumping or flickering of images—but had not mentioned her lack of stereoscopy.
Dr. Ruggiero herself was greatly pleased, she said, when, immediately after achieving flat fusion, Sue experienced stereoscopy. The conscious effort and act of moving her eyes into position for binocular fusion, Ruggiero speculated, may have been critical for Sue’s breakthrough. And she stressed, over and above the initial achievement of stereoscopy, Sue’s adventurous and positive reaction to this and her fierce determination to hold on to it and enhance it, however much work it might entail.
And it did indeed entail, and still entails, a great deal of work—taxing fusion exercises for at least twenty minutes every day. With these exercises, Sue found that she was starting to perceive depth at greater and greater distances, where at first she had seen depth only close up, as with the steering wheel. She continued to have jumps of improvement in her stereo acuity, so that she was able to see depth with smaller and smaller disparities—but when she stopped the therapy for six months, she quickly regressed. This upset her deeply, and she resumed the eye exercises, working on them every day, “religiously.”
Sue uses a kinetic metaphor for her learning to use stereo vision, comparing it to learning to walk again. “I had to develop a new choreography for my own eye movements,” she recently wrote, “how to move my eyes in harmony, before I could tap into latent binocular circuits and see in stereo depth.”
Sue has continued to work very hard on her stereo perception and stereo acuity, and her perception of stereo depth is again on the increase. Moreover, she has developed a skill she did not have when we initially visited her: the ability to see random-dot stereograms. At first glance, these do not appear to contain any images at all. But as one continues to gaze at them through the stereoscope, one becomes aware of a strange sort of turbulence among the dots, and then a startling illusion—an image, a shape, whatever—suddenly appears far above or far below the plane of the paper. This illusion takes some practice, and many people, even those with normal binocular vision, are not able to get it. But it is the purest test of stereoscopic vision, for there are no monocular cues whatever; only by stereoscopically fusing thousands of seemingly random points as seen by two eyes can the brain construct a three-dimensional image.12
David Brewster, a nineteenth-century scientist who was inspired by Wheatstone’s work, observed a related form of stereo illusion. Gazing at wallpaper with small repetitive motifs, he observed that sometimes, with the proper convergence or divergence of gaze, the patterns might quiver or shift and then jump into startling stereoscopic relief, seeming to float in front of or behind the wallpaper.13 Brewster wrote about these stereoscopic illusions, and believed he was the first to observe them—although it seems likely that such “autostereograms” have been experienced for millennia, with the repetitive patterns of Islamic art, Celtic art, and the art of many other cultures. Medieval manuscripts such as the Book of Kells or the Lindisfarne Gospels, for example, contain exquisitely intricate designs done so exactly that whole pages can be seen, with the unaided eye, in stereoscopic relief. (John Cisne, a paleobiologist at Cornell, has suggested that such stereograms may have been “something of a trade secret among the educated élite of the seventh- and eighth-century British Isles.”)
In the past decade or two, elaborate autostereograms have been widely popularized in Magic Eye books. The illusions are single images that one views without a stereoscope; but they contain horizontal rows of repeating “wallpaper” patterns that are slightly different. At first glance, all the patterns seem to be on the same level, but if one learns how to diverge or converge the eyes, letting each eye focus on a different row, then striking stereoscopic illusions appear. Sue loves these, and they have added another dimension to her newfound life in stereo: “I find these wallpaper autostereograms easy (and quite thrilling),” she recently wrote, “probably because I practice convergent and divergent fusion regularly.”
In the summer of 2005, Bob Wasserman and I paid Sue another visit, this time in Woods Hole, Massachusetts, where she was running a fellowship program in neurobiology. She had mentioned to me that the bay there was sometimes full of luminous organisms, mostly tiny dinoflagellates, and that she enjoyed swimming among them. When we arrived, in the middle of August, we found that our timing was perfect; the water was aflame with the luminous creatures (“Noctiluca scintillans—I love the name,” said Sue). After dark, we went down to the beach, armed with masks and snorkels. We could see the water sparkling from the shore, as if fireflies were in it, and when we immersed ourselves and moved our arms and legs in the water, clouds of miniature fireworks lit up around our limbs. When we swam, the night lights rushed past our eyes like the stars streaking past the Enterprise as it reaches warp speed. In one area, where the noctiluca were particularly dense, Bob said, “It’s like swimming into a galaxy, a globular cluster.”
Sue, overhearing this, said, “Now I see them in 3-D—they all seemed to twinkle in a flat plane before.” Here there were no contours, no boundaries, no large objects to occlude or give perspective. There was no context whatsoever—it was like being immersed in a giant random-dot stereogram—and yet Sue now saw the noctiluca at different depths and distances, in three-dimensional space. We wanted to quiz her in more detail about the experience, but Sue, normally eager to talk about stereo vision, was mesmerized by the beauty of the scintillating organisms. “Enough thinking!” she said. “Give yourself to the noctiluca.”
Struggling to find an analogy for her experience, Sue had suggested, in her original letter to me, that her experience might be akin to that of someone born totally colorblind, able to see only in shades of gray, who is suddenly given the ability to see in full color. Such a person, she wrote, “would probably be overwhelmed by the beauty of the world. Could they stop looking?” While I liked the poetry of Sue’s analogy, I was unsure about the thought. (My friend and colleague Knut Nordby, who was completely colorblind, thought that to be given color as an “add-on” after a lifetime without it would be grossly confusing, and impossible to integrate with his already complete visual world. Color, he felt, would be unintelligible and have no associations, no meaning, for someone like him.)
Sue’s experience of stereoscopy, however, was clearly not a gratuitous or meaningless addition to her visual world. After a brief confusion, she embraced the new experience and felt it not as an arbitrary add-on but as an enrichment, a natural and delicious deepening of her existing vision. But terms like “enrichment” or “deepening,” Sue felt, did not begin to do justice to her acquisition of stereoscopy. It was not just a quantitative increase; it was something entirely novel. Stereoscopy, she maintains, is subjectively different.14 This difference even extends to the perception of two-dimensional representations such as photographs, movies, or paintings. Sue now finds these far more “realistic”; her now-activated stereo systems allow her to imagine space in a way she could not before.
David Hubel has followed Sue’s case with interest and has corresponded with her and with me about it. He has pointed out that we are still quite ignorant of the cellular basis of stereoscopy. We do not know whether, even in animals, disparity-sensitive cells (the binocular cells specialized for stereoscopy) are present at birth (though Hubel suspects they are). We do not know what happens to these cells if there is strabismus and lack of binocular experience in early life or, most crucially, whether they can recover if people later learn to position their eyes for binocular fusion. With regard to Sue, he wrote, “It seems to me that [her regaining of stereopsis] occurred too quickly for it to be due to a reestablishment of connections, and I rather would guess that the apparatus was there all along, and just required reestablishment of fusion to be brought out.” But, he added, “that’s just a guess!”
What emerges from Sue’s experience is that there seems to be sufficient plasticity in the adult brain for these binocular cells and circuits, if some have survived the critical period, to be reactivated much later. In such a situation, though a person may have had little or no stereo vision that she can remember, the potential for stereopsis is nonetheless present and may spring to life—most unexpectedly—if good alignment of the eyes can be obtained. That this seems to have happened with Sue after a dormant period of almost fifty years is very striking.
Though Sue originally thought her own case unique, she has found, on the internet, a number of other people with strabismus and related problems who have unexpectedly achieved stereo vision through vision therapy. Their experiences, like Sue’s, suggest that if one has even small islands of function in the visual cortex, there may be a fair chance of reactivating and expanding them in later life, despite a lapse of decades.
Whatever its neurological basis, the augmentation of Sue’s visual world has effectively granted her an added sense, a circumstance that the rest of us can scarcely imagine. For her, stereopsis continues to have a quality of revelation. “After almost three years,” she wrote, “my new vision continues to surprise and delight me. One winter day, I was racing from the classroom to the deli for a quick lunch. After taking only a few steps from the classroom building, I stopped short. The snow was falling lazily around me in large, wet flakes. I could see the space between each flake, and all the flakes together produced a beautiful three-dimensional dance. In the past, the snow would have appeared to fall in a flat sheet in one plane slightly in front of me. I would have felt like I was looking in on the snowfall. But now, I felt myself within the snowfall, among the snowflakes. Lunch forgotten, I watched the snow fall for several minutes, and, as I watched, I was overcome with a deep sense of joy. A snowfall can be quite beautiful—especially when you see it for the first time.”
Postscript
Seven years after acquiring stereoscopy, Sue still delights in her “new” sense and finds her visual world infinitely richer for it. Since writing to me in 2004, she has continued to think about her own experiences and to reach out to many people in similar situations, as well as to vision researchers. In 2009, she published a beautiful and profound book about her experiences, Fixing My Gaze: A Scientist’s Journey into Seeing in Three Dimensions.
Persistence of Vision
A Journal
ON DECEMBER 17, 2005, a Saturday, I had my usual morning swim and then decided to go to the movies. I arrived a few minutes early and took a seat in the back of the cinema—I had no intimation of anything unusual until the previews started. Then I immediately became conscious of a sort of fluttering, a visual instability, to my left. At first I thought it was the start of a visual migraine, but I soon realized that whatever it was affected only the right eye and must therefore be arising in the eye itself, and not in the visual cortex, the way a migraine would.
When the cinema screen went dark after the first preview, the spot that had been quivering to my left flared up like a white-hot coal, with spectral colors—turquoise, green, orange—at its edges. I was alarmed: was I having a hemorrhage into the eye, a blockage of the central retinal artery, a retinal detachment? I then became conscious of a blind spot within the incandescent area, for using just my right eye and looking to the left, where a line of little lights along the floor indicated a way out of the cinema, I found that all the forward ones were now “missing.”
I felt panic rising. Would the dark area continue to enlarge until the right eye was completely blind? Should I leave at once? Go to an emergency room? Call my ophthalmologist friend, Bob? Or should I sit tight and see if the disturbance spontaneously resolved? The film started, but I paid little attention to it; I was entirely preoccupied with checking my vision every few seconds.
Finally, after about twenty minutes, I burst out of the cinema—perhaps everything would look fine once I got into daylight, the real world. But it didn’t. The flaring had died down a little, but when I used only my right eye, a pie-shaped chunk of my visual field was still missing to the left. I walked, almost ran, back to my apartment and phoned Bob. He asked a few questions, suggested a couple of instant tests, then told me to get myself to an ophthalmologist immediately.
A couple of hours later I was in the ophthalmologist’s consulting room. I told my story again, indicated the quadrant of blindness in my right eye. He listened carefully, looked noncommittal, and, after checking my visual fields, took his ophthalmoscope and peered into the eye. Then he put down the instrument, leaned back, and gazed at me, I thought, with different eyes. There had been a certain lightness or casualness in him before—we were not exactly friends, but we were colleagues, both medical men. Now, suddenly, I was in a quite different category. He spoke carefully, picking his words; his demeanor was one of seriousness and concern. “I see pigmentation,” he said, “something behind the retina. It could be a hematoma, or it could be a tumor. If it’s a tumor, it could be benign or malignant.” He seemed to take a deep breath. “Let’s look at the worst-case scenario,” he continued. I cannot be sure what he said next, for a voice had started up in my head, shouting, “CANCER, CANCER, CANCER . . .” and I could no longer hear him. He said he would make arrangements for me to see Dr. David Abramson, a great expert on ocular tumors, as soon as possible.
Back in my apartment that evening, testing my right eye, I was startled to see that the horizontal bars on the air conditioner all seemed to be warped, converging and collapsing into one another, while the vertical bars diverged. I cannot now remember how I spent the rest of the weekend. I was very restless, I went for long walks, and when I was inside, I paced to and fro. The nights were especially bad—I had to knock myself out with sleeping pills.
DECEMBER 19, 2005: DIAGNOSIS
I was able to see Dr. Abramson first thing on Monday. Kate—she is my close friend, as well as my assistant—came with me, for moral support. Dr. Abramson was a quiet man, sober, measured, reserved, with a mischievous glint in his eye. “Nice to meet you,” I said.
“We have met before,” he answered, and reminded me that he had been one of my students, back in the 1960s. He had vivid memories of my teaching and some of my idiosyncrasies. He recalled that my class had been the only one in his medical school career to conclude each week with a general discussion over a cup of tea. How odd, I thought (as perhaps he did), that more than thirty-five years after being his mentor, I was now his patient.
He made a preliminary examination of my eyes, then put some drops in to dilate the pupils. This was followed by photography and an ultrasound examination of the retina. Little was said during these exams. Then we sat down in another, bigger room. Dr. Abramson brought out a large model of the eye, cut open to reveal its inner anatomy. Taking a hideous-looking black object—irregular, convoluted, like a little black cauliflower or cabbage—he placed it near the entry of the optic nerve. The meaning of this was clear: I had a tumor, a malignant one. I thought of how, in England, the judge dons a black cap before pronouncing a death sentence. The black cabbage had the same meaning. I felt that I had been given a death sentence.
“It’s a melanoma,” he confirmed, but immediately went on to say that ocular melanomas rarely metastasized—there was little chance of any spread beyond the eye. Nevertheless, one could not allow it to persist and grow, untreated, in the eye. Until fairly recently, the recommended procedure was removing the entire eye (he himself had done a thousand such enucleations over the years) but now, it was felt, radiation could be just as effective, allowing one to keep the eye and its remaining vision. Dr. Abramson had barely got this out before I asked how soon this radiation could be done: tomorrow? He said there would be a three-week delay—the Christmas and New Year’s holidays were coming up—but there would be no significant growth of the tumor in this time, he reassured me; these things tended to be very slow-growing. It would take some time to fashion the radioactive plaque itself, tailoring it to focus the radiation precisely on the tumor. Then the plaque would be attached to the side of my eye, which would require disconnecting one of the eye muscles. In a second operation a few days later, the plaque would be removed and the muscle reconnected.
My tumor must have taken some time to reach this size, he added—had I observed any defect in my visual field in the months before? Alas, I had never checked it. I had noticed nothing amiss until two days before, in the cinema, and then the odd visual distortions, the warping of horizontals and verticals, over the weekend. This was due to the swelling and distortion of the retina, Dr. Abramson said, and it would disappear as the tumor, and the edema associated with it, yielded to treatment. But if the distortions grew worse, he suggested, I might consider wearing an eye patch for a few weeks until they subsided.
Ocular melanomas were virtually all sensitive to radiation, he continued. There was a very good chance that the tumor could be killed by the radiation, followed, if need be, by lasering. Unfortunately, my tumor was in a bad location—scarcely more than a hundred cells, a single millimeter, from the fovea, the part of the retina that one fixates with, where visual acuity is greatest. But if the tumor could be stopped in its tracks, he said, I would retain, for a while, the 20/20 vision I had always enjoyed in this eye. Later there might be some loss of vision, due to the belated effects of the radiation. Still, I should have a substantial “window”—perhaps years—of good vision before this occurred.
I said to Dr. Abramson, “I guess you have to give news like this to many patients.” I asked how I had seemed to take the news. Very calmly, he said, but it would need some digesting.
DECEMBER 19, 2005
I wake from a nightmare. The moment I open my right eye, I perceive something is wrong. The Darkness has inched forward—I can hardly see anything now to the left. I am calm and rational on the surface; I know that, with David Abramson, I am in the best possible hands, but I feel a terrified child, a child screaming for help, inside me.
DECEMBER 21, 2005
Having cancer, any cancer, means an instant change in status, in one’s life. The diagnosis is a threshold beyond which lies a lifetime, however long, of tests, treatments, vigilance—and always, whether conscious or unconscious, a sense of reservation about the future. Today, the first day of winter, liver function tests are to be done. Has the beast spread to my liver? Does it have its claws in my vitals? Will I die of melanoma? The thought is in my mind all the while.
I have made a bargain with the tumor: you can have the eye, if you insist, so long as you leave the rest of me alone.
At Memorial Sloan-Kettering there is a special sidewalk marked “Reserved for Patients Going to MSK.” I had occasionally noticed it when I visited people at the hospital. “Poor buggers,” I would think as I saw people take it. Now it is the path I take myself.
Blood is drawn—will it be normal? Routine exam: pulse, blood pressure, etc. My blood pressure is up a bit, 150/80—it is normally under 120/70. The elevator to the X-ray suite seems to have a strange, trapezoidal shape, its walls converging inward to the back. Is this part of the funhouse world, the world of metrical and topological distortion, that I will have to traverse? Kate assures me that this time, at least, it is not my eyes. The elevator indeed has a trapezoidal shape.
After a round of tests and paperwork at the hospital, I go back to Dr. Abramson’s office, a few blocks away. I am beginning to know the place and his staff, and they, now, are beginning to know me. I have joined a new club—the Ocular Melanoma Club of Greater New York (just as I belong to the Mineralogical Club of New York . . . and the New York Stereoscopic Society, of which I may soon become the only monocular member).
“December twenty-first, the first day of winter,” I say to Kate.
“An auspicious day,” she replies, trying to cheer me up. “The days start getting longer.”
“Yours, perhaps,” I remark darkly.
DECEMBER 22, 2005
4 A.M.: Woke. Cold. The fear. I open my right eye. The Darkness has grown again, is coming to encircle my little island of vision, my fixation point, my fovea. Soon it will be engulfed entirely.
10 A.M.: Vision much better. I think my 4 a.m. observation was related to the semidarkness of my bedroom and the fact that (as I am learning) the blind area, the scotoma, varies with the illumination—it can get larger and even knock out central vision if the light is dim.
When I close my right eye, I again see brilliant lights, the blinding lights that herald blindness. A scalloped crescent, with a Technicolor edge, just above my fixation point.
DECEMBER 23, 2005
I find that if I use just my right eye, I cannot read—the lines are indistinct, slippery, grossly distorted; they waver from moment to moment. I had not realized that this would be upon me so soon. Perhaps I have avoided reading these last few days, or done it wholly with my left eye, without realizing it. I am tending to close my right eye when I read—this is unconscious, involuntary, almost automatic.
DECEMBER 24, 2005
Waking after a good night’s sleep, and with the morning sun pouring in through my windows, I forgot for a moment that I am now a “cancer victim.” I felt well, and the visual symptoms were not intrusive. Feeling well is always a bit dangerous for me—it tempts me to excess. This morning at the pool, I swam for too long: an hour, mostly backstroke, but then several lengths of freestyle, which Dr. Abramson had advised against (as, perhaps, tending to cause the retinal edema to pool), followed by a half hour of vigorous exercises with mat and ball. It was at this point that my vision started to go again—testing my right eye an hour later, I found I could not read even the large headlines of the New York Times. This terrified me, showed me what loss of central vision was like.
Now, two and a half hours later, the edema is settling (if it was edema), though vision in the right eye is still swimmy: lines and surfaces snake and curve. I find it easier to put a patch on the right eye and use just the left, which at least has stable vision.
Inside the blazing, coruscating margin of the scotoma, involuntary imaging of all sorts—faces, figures, landscapes—is going on continually. I have had similar images briefly at the start of a migraine or before falling asleep, but never, as far as I can remember, continuous imagery as I have now.
DECEMBER 25, 2005
Everyone says “Merry Christmas!” and I reply in kind, but this is the darkest Christmas I have ever known. The New York Times today has pictures and stories of various figures who have died in 2005. Will I be among those figures in 2006?
Kate tries to remain upbeat. “Dr. Abramson said that this would not kill you,” she said. “Whatever happens, we will deal with it.” I am not so sure. The idea of blindness terrifies me, as does the thought that perhaps I will be among the unlucky one percent.
DECEMBER 30, 2005
8 A.M.: This morning when I opened my eyes, the dark cloud in the right eye was much larger. Sitting up and looking out the window with the right eye, I could hardly see the sky at all, and I found, looking up at the center of my ceiling fan, that three of its five blades were scarcely visible to my right eye—I could see just the stumps of the blades, close to my fixation point.
10 A.M.: Now, after being up for two hours, I find that the scotoma has retreated and that I can see all but one blade. Position is important, since the edema seems to pool when I lie flat at night—perhaps I should sleep with my head propped up.
I find it difficult to concentrate, to compose myself. Difficult, too, to write—I have not written anything (other than brief letters) since completing a chapter on musicogenic epilepsy a week ago—though I have been thinking, at least, of synesthesia and music.
4 P.M.: Mood and energy much better! I have just written the greater part of “Colored Music,” my chapter on synesthesia.
JANUARY 1, 2006
On this New Year’s Day, I find myself entertaining fears and hopes, facing challenges of an entirely new kind. There is a small but significant chance that this will be my last year—but whether or not this is so, my life will certainly be transformed, has already been transformed, in a radical way. Questions of love and work, of what really matters most, have taken on a special intensity and urgency.
JANUARY 5, 2006
I am impatient and annoyed that I must wait so long for the surgery. Has this holiday period cost precious time, allowing the tumor to continue eating away at my vision? I am reassured that Dr. Abramson will do everything possible to kill this tumor, while preserving as much of my sight as possible. And I am glad to have met himagain (though not in these circumstances). He is not only a brilliant physician but an extremely sensitive man—very important when dealing with people who have cancer. He never seems hurried or impatient. He listens carefully to what I say and responds with great delicacy and tact. I think he has my measure, as well as the melanoma’s.
JANUARY 8, 2006
I slept fitfully last night, with dreams and anxieties about the eye, about vision—and, beyond this, about my life. Fears of every sort are rushing through my mind, mixed with (futile) regrets and recriminations that the tumor was not diagnosed earlier. Why did I not realize the import of those close-set wavy lines, the little stars and tussocks, which I had been seeing on the white ceiling of the swimming pool for the last few months whenever I did the backstroke? How could I be so absurd as to dismiss them as “fragments of migraine” or a reflection of my eyelashes in the goggles, when a moment’s experiment would have shownme—as I found yesterday—that they were only to be seen with the right eye and equally visible without the goggles? I could, should have paid attention, questioned, sought clarification months ago.
Bob, however, feels that this would not have made an appreciable difference, but what is damnable—and here I am mad at my former eye doctor, at Kate, and at myself—is that my “annual” eye exam was somehow missed two years in succession, so I went thirty-two months without an eye exam. This delay could perhaps cost me my vision, even my life—but I must not think on this; must focus instead on how fortunate I am that the thing has been caught now and, as Dr. Abramson says, is wholly treatable.
JANUARY 9, 2006: SURGERY
10 A.M.: I am due to go to surgery in an hour or so; I do not know how conscious I will be, or want to be. With previous operations—shoulder and leg surgery—I was eager to know, almost to participate in the proceedings. This time I would like to be out, completely out. Kate and Bob are here with me and are trying to reassure and distract me.
5 P.M.: I was—happily, deliciously—out of it during the procedure. As the fentanyl took effect, the sciatica I have been plagued with for months disappeared, and I drifted into an unconsciousness deeper than the deepest sleep. When I came to, Dr. Abramson asked me a question or two to test my orientation and cognitive status. Where was I? What had been done? I replied that I was in the recovery room and that he had detached the lateral rectus muscle of the right eye and attached the plaque containing radioiodine (I-125, to be precise) to the sclera. I said that I was sorry it was not radioactive ruthenium instead of iodine (I have a thing for the platinum metals) but that 125, at least, was memorable for being the smallest number that was the sum of two squares in two different ways. I startled myself as I said this; I had not thought it out before—it just jumped into my mind. (I realized, a few minutes later, that I was wrong—65 is the smallest such number.) I continued in a loquacious, slightly euphoric state and, for me, an unusually amiable and sociable one, chatting with all the nurses. Kate came in to visit me in the recovery room (she told me later that she had to reassure the nurses that my low pulse is normal, for I am a long-distance swimmer).
Now, six hours later, lying in bed, I see occasional sparkles, scintillations, in my right eye. I wonder if these are from particles or rays emitted by the radioiodine hitting my retina. (It makes me think back to the radioactive clock dials my Uncle Abe used to make, and how I would press these against my closed eyelids as a child and see similar scintillations . . . could this have played a part in causing my tumor?)
My eye is covered by a thick wad of gauze and a rigid eye patch to protect the eye from any jostling. There is a radioactivity warning sign on my door. People can only enter my room provided they obey instructions—and I cannot leave it. No children or pregnant women are permitted, and no one is allowed to kiss me for the days that my radioactive plaque is in place. I am not allowed to go home; I am under hospital arrest. I am “hot.”
JANUARY 10, 2006
4 A.M.: Up, restless, can’t sleep anymore. The patch presses on my eye, oppresses me (someone had the witty thought of bringing in a book called The Blindfold, by Siri Hustvedt), but my sciatica—which has tormented me for months—is still, mysteriously, in abeyance. The room is quiet, peaceful, undemanding, and I can gaze at the East River slowly moving by.
9 A.M.: Looking through the window, with my unpatched left eye, I am startled to see cars stuck in the branches of trees, like toys. With one eye occluded, I have no sensation of distance or depth whatever, a foretaste of what it will be like if I lose central vision in the right eye.
3 P.M.: Visitors and phone calls nonstop since this morning. Wonderful—but exhausting. Kate went out to find me some comfort food and came back with a bagel and whitefish; other friends have brought chocolates and fruit, matzoh ball soup, challah and schmaltz herrings. It is herring and smoked fish I crave most when I am down. Between that and the hospital food, I am well stocked and quite happy to be alone now.
4 P.M.: A pall has descended over the city—a soft gray mist rendering the East River invisible and softening the blocky outlines of the buildings around me. A gentle, beautiful pall.
5 P.M.: A sudden stabbing pain in my eye, then a turmoil of raying purple forms, starfish, daisies, expanding outward from a multitude of separate points. This turmoil seems to fill the whole visual field. It fascinates and frightens me. Is something adrift, askew, amiss in the eye? Or is it my brain filling in, generating visions, in reaction to the cutting off of vision from the operated eye?
7 P.M.: Dr. Abramson came in for a long chat around six o’clock: How was I feeling generally? And what about the eye? I described my “visual storm,” the starfish, etc. He thought it was probably a retinal reaction to the radiation. Picking up on this, I mentioned my thought—half serious, half joking—that the radioactivity in my eye might be strong enough to make my fluorescent minerals glow. Perhaps I could light them up by fixing my radioactive eye, my rays on them—it would be quite a nice party trick! Dr. Abramson was amused, said I should ask Kate to bring the minerals in, and that he would take off the dressing so I could try.
He spoke, too, of how, in a few weeks, it might be a good idea to laser the retina and kill any malignant cells that might have survived the radiation. But my tumor is almost on top of the fovea, and if the fovea is destroyed, I will lose all central vision. He wondered about a compromise: lasering the two-thirds of the tumor farthest from the fovea, but keeping well clear of the fovea itself. He mentioned some newer treatments as well: injections of a substance into the eye that may prevent the growth of blood vessels within the tumor and thus starve it of blood; and a new anti-melanoma vaccine, still experimental. But for the moment, this is all in the future, hypothetical; he hopes radiation and lasering will do the trick.
In the meantime, I still have another thirty-six hours until Thursday afternoon, when I will go into surgery again to have the radioactive plaque removed.
JANUARY 11, 2006
My good friend Kevin came by at 6:15 this morning, a startling but very welcome apparition, with his huge, bushy eyebrows. He had been making early rounds on his patients and was still in his white coat. “Look!” he said, pointing to the window, and I looked—and saw a most delicate, rosy dawn transfusing the night sky and then a smoky, almost Krakatoa-like sunrise over the East River.
My scotoma itself is not so much like a blind spot as like a window, through which I see strange buildings, figures moving, little scenes playing themselves before me. At other times, I see writing, jumbled letters that I cannot read—hieroglyphs or runes—all over the scotoma. Once I saw an immense circular segment with numbers on it, like part of a clock or an Aztec calendar. I have no power to influence any of these visions; they proceed autonomously and have no connection that I can discern with what I am thinking or feeling. The sparkles, the visual storms, may come from my retina, but these visions, surely, must come from a higher level, must be constructed by my brain, calling, if indirectly, on its stock of images.
If I have been looking at something and then close my eyes, I continue to see it so clearly that I wonder whether I have actually closed my eyes. A startling example of this happened a few minutes ago when I was in the bathroom. I had washed my hands, was staring at the washbasin, and then, for some reason, closed my left eye. I still saw the washbasin, large as life. I went back into my room, thinking that the dressing over the right eye must be absolutely transparent! This was my first thought and, as I realized a moment later, an absurd one. The dressing was anything but transparent—it was a great wodge of plastic, metal, and gauze half an inch thick. And my eye, beneath it, still had one of its muscles detached and was in no position to see anything. For the fifteen seconds or so that I had kept my good eye closed, I could not have been seeing anything at all. Yet I did see the washbasin—clear, bright, and real as could be. For some reason, the image on my retina, or in my brain, was not being erased in the normal way. And it was not a mere afterimage. Afterimages, for me at least, are brief and meager in the extreme—if I look at a lamp, I may see the glowing filament for a second or so—whereas this image was as detailed as reality itself. I continued to see the washbasin, the commode next to it, the mirror above it, the entire scene for a good fifteen seconds—a genuine persistence of vision. Something very odd was going on in my brain. I had never experienced such a phenomenon before. Was this—like my involuntary images, my hallucinations of patterns, of people—simply a consequence of being blindfolded in one eye? Or was it the angry, half-destroyed, cancered retina, now in a blaze of radiation from the radioiodine, sending strange wild signals to my brain?
JANUARY 12, 2006
8 A.M.: This afternoon, after precisely seventy-six hours, the radioactive implant will be removed, the disconnected eye muscle reconnected; and if all goes as it should, I will be released from the hospital tomorrow.
6 P.M.: I thought this surgery would be as sweet and painless as the first one, but when the anesthesia wore off I had the worst pain I have ever known—it made me gasp. I can avoid it only by keeping the eye completely still; the slightest movement seems to tear at the just reconnected eye muscle.
7 P.M.: Dr. Abramson came in to check my eye. He took off the patch; everything was very blurry, but this, he said, would clear in a day or so. He gave me careful instructions about putting drops in the eye several times a day, said I should not worry if I had transient double vision, and that I should feel free to call him, day or night, if I felt anything untoward was happening.
There is an unpleasant feeling of stickiness, crustiness, in the eye, perhaps from all the eyedrops. I have to fight against the impulse to rub it.
MIDNIGHT: Finally, the pain is beginning to be tolerable. Over the past six hours I have had huge doses of Percocet and Dilaudid. Nothing seemed to touch the pain, until, an hour ago, Dr. Abramson ordered a whopping dose of Tylenol. Oddly, this did the trick, when the opiates had failed to help.
JANUARY 13, 2006
I came home this morning. Patients are usually glad to get out of the hospital, but I was rather sorry to leave. In the hospital, I was surrounded by attentive people, catering to every need; I was visited constantly, pampered. And now all this has gone, and I am back in my apartment, alone. I can’t go out—there has been a heavy snowfall, the streets are icy—and I dare not go for a walk with, in effect, only one eye at the moment.
JANUARY 15, 2006
7 A.M.: There was a snowstorm, a howling gale, in the night, but it looks pretty, what I can see of it now. Mornings are worst. I wake to a small, dim, bleary window of vision in my right eye, with streaks and blotches moving across it and gross distortion of horizontals and verticals, as one might get with a fish-eye lens.
10 A.M.: It has been almost a week since the surgery, and tired of staying inside, I ventured out, despite the snow, on a friend’s arm. It is extremely cold, icy, windy outside. The wheels of cars spin helplessly, and we saw one car, parked on ice, actually blown forward an inch or two by a sudden, gale-force gust.
Everything in the right eye is swimmy, not only metaphorically but literally so—I am looking through a shifting film of fluid. The shapes of everything are fluid, moving, distorted. I imagine my retina almost afloat in the fluid pooling beneath it, changing shape like a jellyfish, or maybe a waterbed.
Looking through a window at a tall rectangular building across the street, I see it, as in a fun house, with its top or its middle (depending on where I fixate) splayed out and bulbous. This happens with all verticals; horizontals tend to be squashed together. In the bathroom mirror, the upper part of my reflection is distorted—my head looks grotesquely flattened.
I am told that these effects come from edema beneath the retina and will resolve in a few days. I cannot always believe this; I feel that something approaching blindness in my right eye has descended on me far faster than I (or anyone else) would have predicted. Along with this is the suspicion that there was a fatal delay between diagnosis and treatment. That in those three weeks, additional and irreversible damage was done, as vision declined from a smallish blind spot to a virtual obliteration of the whole upper hemisphere of vision. I cannot help feeling that the melanoma should have been treated as an emergency and radiated without delay. I am sure I am being irrational, I hope I am wrong on these matters—but they form a nucleus of distrust and suspicion, which can get blown up into a tornado of paranoia.
JANUARY 16, 2006
Have just written to Simon Winchester, telling him how much pleasure I have got from listening to the audiotape of his book Outposts.
I live in a world of words, and I need to read; much of my life is reading. This is not easy now, with my right eye being “out” for the moment, and the left eye with long-standing problems of its own. I was punched in the left eye as a boy, which produced a cataract, and its vision has been below par ever since. This didn’t matter when my dominant right eye had 20/20 vision, but now it does. My regular reading glasses are not strong enough for my left eye; I have to use a magnifying glass, which makes reading much slower and prevents me from scanning whole pages at a time.
Wandered out with Kate to the bookstore to get some large-print books—dismayed to find that almost all their large-print books are how-to books or romance novels. I could hardly find a single decent book in the entire large-print section. It is as though the visually impaired are also regarded as intellectually impaired. I feel like writing a furious op-ed about this for the Times. Audiobooks have a larger range, but I have been a reader all my life, and am not fond of being read to, on the whole. The Simon Winchester was a pleasant exception to the rule.
JANUARY 17, 2006
Dr. Abramson cautioned me that while the retina is still swimming in edema, I may see clearly one day and be almost blind the next, but I still overreact to these fluctuations—exulting at the good times, despairing at the bad. “I librate between a glum and a frolic,” as W. H. Auden put it in his poem “Talking to Myself.”
I miss swimming terribly—the swimming pool is where I feel best, think best, and I need it every day. But I am not allowed to swim for two weeks following the surgery. Dr. Abramson knows well what a deprivation this is for me; he is a passionate swimmer, too—the walls of his office display various medals he has won. He might have been a professional athlete if he had not chosen medicine.
Not wanting to bother Dr. Abramson (though he said I should feel free to call him), I phoned Bob this morning to ask if he would check my eye. He came along with his ophthalmoscope, dilated the pupil, had a long, careful look, and then drew me a picture of what he saw: the melanoma like a black mountain in the middle of my retina; one side so steep, he said, it looked like “a cliff.” He saw no signs of hemorrhage or anything amiss. But the blinding light of his ophthalmoscope caused me to lose all central vision in the eye for several hours. Whatever I looked at with my right eye disappeared—the center of my clock disappeared, leaving a halo of peripheral vision around it (I dubbed this, in my mind, “bagel vision”). It gave me a sense of horror. If this were permanent and if it affected both eyes, it would be terribly incapacitating—is this what people with macular degeneration have to live with?1
JANUARY 18, 2006
NOON: The eye was still quite blurred and dilated at nine o’clock this morning, but in the past three hours this has diminished, and the 12 and 1 are starting to be visible again when I fixate on the center of the clock.
But something has happened to the perception of color in the eye. When I went for a stroll this morning, a bright green tennis ball lying in the gutter lost all its color when I looked at it with just my right eye. Similarly with a Granny Smith apple and a banana—both turned a horrid gray. Holding the apple at arm’s length, I find the central gray-out surrounded by a normal green, as if color vision is preserved around my fovea but not in it. Blues, greens, mauves, and yellows all seem to be attenuated or lost; bright reds and oranges are the least affected, so when I pick an orange from my fruit bowl to test myself with, its color looks almost normal.
JANUARY 25, 2006
Today and yesterday, the twelfth and thirteenth days after the end of the radiation treatment, I observed, for the first time in a week, definite signs of improvement. Apples are starting to regain their greenness, and acuity too has improved. Last night I was able to read normal-sized print (Luria’s autobiography) for half an hour before I went to sleep. I had not been able to read myself to sleep, my usual custom, for most of the month, since going into the hospital.
But strange dreams, sometimes nightmares, continue. In one, two nights ago, people were being tortured, blinded, by having red-hot needles thrust into their eyes. When it was my turn I struggled, let out a feeble cry, and tore myself into wakefulness. Yesterday I was awakened (or perhaps I was only half asleep) by lightning. I was surprised—no storms had been predicted—and waited for the thunder. No thunder. The sky was clear. I then realized that this had probably been a flash from my damaged and abnormally active retina. I had had scintillations before, and coruscation, but never a fulguration of this sort.
This morning I dreamt of a grove of tea trees, which, I understood, exerted a powerful protection against cancer if one lived beneath them.
JANUARY 26, 2006
It is only 8 a.m., and there are already nine people here in Dr. Abramson’s waiting room. Do they, do we, all have ocular melanoma? There are no children today, but there are several youngish adults, of both sexes, though ocular melanoma is commoner after the age of sixty. Was I carrying an ocular melanoma gene at forty, or twenty? Or was it a mutation, one of the many, ever increasing on our polluted, carcinogenic planet?
I tell Dr. Abramson about the temporary loss of central vision in the right eye following the blinding light of Bob’s ophthalmoscopy and the color changes I had noticed since. All this, he says, while perhaps exacerbated by the surgery, the radiation, the blinding light, is probably temporary and should disappear. Upon examination he sees a bit of necrosis and calcification of the tumor—the expected result of radiation. His impression: we are “on course,” but I will probably need “touch-up” lasering in a month or so. I don’t need to limit my activity anymore; I am free to swim. Hoorah!
7 P.M.: Despite everything, it has not been a wholly unproductive week. Kate has typed (and enlarged) two of my music chapters for me to go over, and I have seen several people with synesthesia this week, all fascinating in their different ways. Perhaps, in spite of my difficulties reading and my obsession with testing visual fields, color changes, etc., I can still hope to complete my music book.
For the next few weeks, I continued to experience fluctuations, with the right eye almost blind on some days and better on others, with “fish-eye” distortions and great sensitivity to light. I had to wear large, all-enveloping sunglasses outside and avoid dazzling sun or flashbulbs, which could blind me in that eye for hours. I wore a patch on the eye for much of the time, so that the normal image from my good, left eye would not have to compete with the distortions from the right eye. In March, Dr. Abramson followed up my radiation treatment with some lasering, and a couple of weeks later, the edema finally started to subside. With this, the vision in my right eye started to stabilize, the distortions and light sensitivity gradually disappearing.
Abnormalities in color perception, however, remained, although (unlike the distortions) these were not apparent if I used both eyes. If I closed my good eye, I suddenly found myself in a different chromatic world. A field of yellow dandelions would suddenly become a field of white dandelions, while darker flowers would turn black. A bright green fern, a selaginella, turned a deep indigo when I scrutinized it through a lens with my right eye. (My right eye was always the dominant one, and I would automatically hold a lens or monocular to that eye, even though it was now so much worse than the left.)
There were also curious suffusions or diffusions of color. When, for example, I looked with my right eye at a pale mauve flower surrounded by green leaves, the green surround took over and filled in, so that the whole flower appeared green. When I looked at a meadow of bluebells and closed my left eye, the bluebells turned green, no longer distinct from the vegetation around them. It was like a conjuring trick—now you see it, now you don’t—and quite extraordinary to perceive such different worlds with each eye.
When I saw Dr. Abramson in May, he said that the edema had entirely gone and the tumor had started to shrink, and that with luck, I might hope to enjoy good and stable vision for years to come.
All continued well over the next two months, and I made fewer and fewer entries in the heavy black notebooks marked “Melanoma Journal.” I did not resume detailed notes for almost a year. But starting in July 2006, there was a gradual return of visual problems—especially distortion, diminished acuity, and sensitivity to light—and some regrowth of one area of the tumor.
Dr. Abramson used the gentler word “persistence” to describe this and thought that another, milder lasering would take care of it. But when I had the procedure in December, it did not help. It began to look as if that narrow strip of retina next to the fovea, which he had carefully avoided lasering in order to maintain some central vision, would have to be sacrificed after all.
By April 2007, distortions had become extreme in the right eye, and this affected my vision even with both eyes open. People turned into bizarre, elongated, El Greco–like figures, tilted to the left—they made me think of the insectlike Selenites pictured in my edition of H. G. Wells’s The First Men in the Moon. And the sort of visual spread which had started a year before, at first confined to colors, now affected everything I looked at. Faces, in particular, would develop translucent, puffy, almost protoplasmic protuberances, like a Francis Bacon portrait.
I found myself involuntarily closing my right eye more and more. Its acuity, by May of 2007, had plummeted to 20/600—I couldn’t read the largest letter on the screen. Up to this point I had thought of losing central vision as a disaster, but now my sight was becoming so poor and so distorted that I began to wonder whether I would do better with no central vision in the right eye at all. Increasingly, it seemed, there was less and less to lose—so we scheduled a third lasering, which would finally knock out the rest of the tumor and, perhaps, the remaining central vision in that eye.
JUNE 2007
The lasering, a couple of weeks later, took about an hour, involving dozens of minute cauterizations, and I left the hospital with a heavy dressing over the eye, to protect it until the anesthesia wore off. Around 9 p.m. that night, I removed the dressing, not knowing what I would see, or not see.
I saw a huge black opacity partly obscuring central vision, like an amoeba with pseudopodia. It seemed to expand, contract, pulse—but its edge was razor-sharp. I stuck a finger into it, and the finger vanished, engulfed as by a black hole. Going to the bathroom mirror, facing my reflection, I could not see my own head with the right eye—only my shoulders and the bottom of my beard. I could not see the tip of the pen when I wrote.
When I went out the next morning, I saw only the lower halves of people walking. I was reminded of how, in Joyce’s Ulysses, there is a Signor Artifoni who is characterized as “a pair of stout trousers” walking around Dublin. The streets were full of skirts and slacks, moving legs and hips with no upper halves. (A few days after this, the scotoma spread, and I could see only their feet.)
This, of course, is when I close the left eye. With both eyes, my vision is now remarkably “normal”—far more so than it has been for months, now that the right eye does not interfere with the left. It is out of the running, completely blind, at least so far as central vision goes. Oddly, this is a huge relief—I wish I had had it lasered months ago.
Stereo vision, however, now that I am mostly monocular, is quite compromised—completely missing in the upper half or two-thirds of my visual field, though partly intact in the bottom, where I retain some peripheral vision. So I see the lower halves of people in stereoscopic depth, while their upper halves are completely flat and two-dimensional. And, of course, as soon as I look at their lower halves, using what is left of my central vision, these become flat, too.
That first evening when I took off the bandage, I saw with my right eye a black blob, an amoeba. By the next day, this had settled into a darkness with the shape of Australia, complete with a little bulge in the southeast corner—I thought of this as its Tasmania. I was struck that first night by the fact that when I looked up at the ceiling, the blob disappeared, becoming so camouflaged that I could no longer be sure of its existence. I had to test to be sure, but it was still there—my black hole had become a white hole, had taken on the color of the ceiling around it. It was still a hole, and if I brought my finger from periphery to center, the finger would disappear as soon as it crossed the now-invisible margin of the scotoma.
I knew that the normal blind spot, which we all have, where the optic nerve enters the eye, is automatically filled in, so we are unaware of its existence. But the normal blind spot is tiny, whereas my own scotoma was huge, blotting out more than half of the entire visual field of the right eye. And yet, within a second or two of looking at a white surface, it could completely fill in, becoming white instead of black. The next day I tested this with a blue sky and found the same result. The scotoma became as blue as the sky, but this time I had no need to plot its margins with my finger, for when a flock of birds flew by, they suddenly disappeared into my scotoma, emerging on the other side a few seconds later—as if they had been cloaked in invisibility like a Klingon warship.
This filling in, I discovered, was strictly local, depending on a steady fixation of gaze. If there was a slight movement of the eye, the filling in dissipated, and the ugly black amoeba was back. Local, but persistent, for if I looked at a red surface for a few minutes and then at a white wall, I would see a large red amoeba (or Australia) on the wall, which would last about ten seconds before it turned white.
The blind spot, so called, does not just fill in color, it fills in patterns too, and I enjoyed experimenting with my own scotoma, testing its powers and limitations. It was easy to fill in a simple repetitive pattern—I started with the carpet in my office—though a pattern took a bit longer than a color, perhaps needing ten or fifteen seconds to duplicate. It would fill in from the edges, like ice crystallizing on a pond. The spatial frequency and fineness of detail in the pattern was crucial. My visual cortex had little trouble filling in fine-grained patterns, but coarser patterns were beyond it. So if, for instance, I stood two feet from a brick wall, my scotoma would turn brick red in color, but with no detail. If I stood twenty feet away, it would be filled in by perfectly respectable-looking brickwork.
Whether the brickwork was exactly the same as the original I could not be sure, but it was good enough to form a plausible simulacrum of the “missing” wall. I could be sure of exact replication only if I was gazing at absolutely predictable, repetitive patterns like chessboards or wallpaper. Once when I looked at a sky filled with fat woolly clouds, the pseudo-sky generated within the scotoma contained thin wispy clouds. I felt that my visual cortex was doing the best it could, perhaps by sampling or estimating the ratio of white cloud to blue sky, even though the actual shapes of the individual clouds were not right. I started to think of my visual cortex not just as a rigid duplicating device, but as an averaging device, capable of sampling what was presented to it and making a statistically plausible (if not photographically accurate) representation of it. I wondered if this was what cuttlefish and octopuses did when they camouflaged themselves, taking on the colors, patterns, and even textures of the seafloor or plants or coral around them—not exactly, but plausibly enough to fool both predators and prey.
I found that movement could also be filled in to some extent. If I looked at the Hudson River, slowly swirling or rippling with small waves, these too were reproduced in my scotoma.
But there were strict limits. I could not simulate a face, a person, a complex object. I could not fill in my own head in the mirror when it was blanked out by my scotoma. And yet here I made another discovery, one that filled me with wonder. Idly playing, scotomizing, one day, I looked at my foot with my right eye and “amputated” it with my blind spot, a little above the ankle. But when I moved my foot a little, wiggling the toes, the stump seemed to grow a sort of translucent pink extension with a ghostly, protoplasmic halo around it. As I continued wiggling my toes, this took on a more definite form until, after a minute or so, I had a complete phantom foot, a visual phantom equipped with the missing toes, which seemed to move with the movements I was making. The foot did not look wholly solid or real, for it lacked surface detail, the appearance of skin—but it was very remarkable nonetheless. A similar thing occurred with my hand if I scotomized it, “amputated” it above the wrist. I subsequently tried to do the same with others’ hands, but that did not work in the least. It was clear that my own foot or my own hand, my own movements and sensations, my own body image or intentions, were required.
After my lasering in June, I noticed that I could visualize my arms or other parts of my body in action, even when my eyes were closed, much more clearly and vividly than I had ever done before. “Seeing” my arms as I moved them seemed to attest to a heightened sensitivity or connection between the visual and the motor areas of the cortex—an intensity of communication or correlation between them unprecedented in my experience.
Another odd thing struck me within a day or two of the lasering in June of 2007. At one point, after gazing at the bookshelves in my bedroom for a few minutes, I closed both eyes and saw, for ten or fifteen seconds, the hundreds of books arrayed on the shelves in great, almost perceptual detail. This was not filling in but something quite different—a persistence of vision similar to what I had experienced in the hospital eighteen months earlier, when I seemed to see the washbasin so clearly “through” my eye patch.
Perhaps the loss of central vision in the right eye was equivalent to having it covered by a postoperative patch, in terms of depriving the brain of perceptual information. I had the sense that my visual cortex was now in a heightened or sensitized state, released to some extent from purely perceptual constraints.
Something similar happened a few days later, as I walked up to a crowded intersection full of bicycles, cars and buses, and people bustling in all directions. When I closed my eyes for a minute, I could still “see” the whole complex scene, full of color and movement, as clearly as if I had my eyes open.
I found this especially surprising, since I normally have very meager powers of visualization. I have difficulty evoking a mental picture of a friend’s face, or my living room, or anything at all. The persistence of vision I had experienced was richly, mindlessly detailed, much more so than any voluntary image. It was so detailed I could see the colors of cars and sometimes read their license plates, to which I had paid no conscious attention. Involuntary, unselective, unstoppable, the image seemed to me akin to photographic or eidetic imagery—but, unlike eidetic imagery, it had a very definite and brief duration, lasting ten or fifteen seconds and then fading.
At one point, as I was walking with a friend, I saw two men walking towards us, both wearing white shirts, brilliantly clear in the late-afternoon sun. I stopped and closed my eyes, and found that I could continue to watch them, seemingly still walking towards us. When I opened my eyes, I was startled to find that the men in white shirts were nowhere to be seen. They had, of course, walked past us, but I was so engrossed in what I “saw” with my eyes closed—an arrested fragment of the past—that I got a sudden shock of discontinuity. I say “arrested,” but what I saw in my mind’s eye had motion, too. The men were walking, striding, yet they remained in the center of my mind’s eye as they walked, without getting anywhere, as if on a treadmill. I had captured this bit of motion, like a film loop, which recycled in my mind even after they had gone. This had a paradoxical quality, like a snapshot of movement without any actual transit.
I rather enjoyed this persistence of vision, and Times Square, with its brilliant colored lights, its moving and flashing billboards, became a favorite place for testing it. The most potent stimulus of all was optic flow, a brisk stream of images past my eyes, which I could especially relish when I was a passenger in a fast-moving car.
I felt there was an analogy and perhaps a kinship between the filling-in phenomenon and the persistence of vision. Both came on strongly after the loss of central vision, though there had been intimations of both before. Both remained strong for two to three months in the summer of 2007 and then grew weaker (though they continue, in an attenuated form, to the present). “Filling in” seemed to me an inadequate term for a process which did not always confine itself to reconstituting a blind area but could go on to a sort of incontinent visual spread. (This, too, had been foreshadowed in those last, half-blind weeks before the June lasering, when faces spread and protuberated like monstrous, Francis Bacon faces.)
I experimented with this visual spread one day by gazing with my right eye at an old tree with a particularly exuberant and brilliantly green mass of foliage. Filling in soon occurred, so that the missing area turned green and textured to match the rest of the foliage. This was followed by a “filling out,” an extension of the foliage, especially towards the left, resulting in a huge lopsided mass of “leaves.” I realized how outlandish this had become only when I opened my left eye and saw the tree’s actual shape. I went home and looked up an old paper by Macdonald Critchley on types of “visual perseveration” which he called “paliopsia” and “illusory visual spread.”2 Critchley saw these two phenomena as analogous: one a perseveration in time, the other a perseveration in space.3
Here perhaps one has to use the word “pathological,” for one can hardly have a normal visual life if every perception gets extended and smeared in space and time; one needs restraint or inhibition, clear boundaries, to preserve the discreteness of perception.
Critchley’s patients had brain tumors or other cerebral disorders, whereas I had only retinal damage. Yet clearly I was also experiencing cerebral phenomena—I supposed that retinal impairment had led to some abnormal excitation in my visual cortex. Many years ago—I described this in A Leg to Stand On—I had an injury to the nerves and muscles in one leg that caused some strange cerebral symptoms similar to those of a parietal lobe disorder. When I wrote to the Russian neuropsychologist A. R. Luria about this, he spoke of “the central resonances of a peripheral disorder.” Now I was experiencing such a resonance in the realm of vision.
In June of 2007 I also had a sharp surge of hallucinations—apparitions that came out of the blue and had no relation to the external world—and this has continued, to some extent, ever since. Neurologists speak of simple or elementary visual hallucinations, as opposed to complex ones. In the simple ones, there are hallucinations of color, shapes, and patterns; in the complex ones, there may be figures, animals, faces, landscapes, etc. For the most part, I have simple ones.
Almost from the start, sparks, stripes, or blobs of light have appeared in my visual field, as well as complex patterns resembling alligator hide. I sometimes think that a wall is patterned or textured when it is not, and have to touch it to be certain whether the stippling I see is real.
I often see a multitude of little tufts, like tussocks of grass, all over my visual field, even with both eyes open. At other times there are checkerboards, usually black-and-white, but sometimes faintly colored. The apparent size of these checkerboards depends on where I am “projecting” them. If I look at a piece of paper six inches away, I might see a checkerboard on it the size of a postage stamp; if I look at the ceiling, it might appear to be a foot square; if I look at a white wall across the street, the checkerboard might be the size of a shop window. Some of my checkerboards are rectilinear, others are curvilinear, and some have an almost hyperbolic shape. Sometimes one checkerboard will undergo fission or multiplication, becoming a dozen smaller checkerboards, arrayed in rows and columns. Complex patchworks or mosaics are common, too, and seem to be variants or elaborations of the basic checkerboard patterns. These tend to switch from one to another in constant, kaleidoscopic change.
I also see tilings or tessellations composed of polygonal (often hexagonal) pieces, some flat and some three-dimensional, like honeycombs or radiolaria. Sometimes there are spirals or concentric rings, or radial patterns like filigreed doilies. Occasionally I see “maps”—maps of enormous, unknown cities, as might be seen at night from a low-flying airplane, with ring roads and radial spokes illuminated, looking like giant spiderwebs of light.
Many of these patterns are microscopically detailed. I see thousands of lights in my nocturnal cities. These images or hallucinations have greater clarity, are more fine-grained, than perception itself, as if my inner eye had an acuity of 20/5 rather than 20/20.
The most constant patterns (perfectly visible with both eyes open, and especially so if my visual field is otherwise blank) are sticklike or occasionally curved patterns resembling letters or numbers. Occasionally I recognize a 7 or a Y or a T or a delta, but for the most part they are unintelligible, like runes. They make me think of a child’s letter box, with letters spilled out at random and at all angles. These are rather faint and often have double lines, giving the impression of being incised like the lettering on a stone. These pseudo-letters and pseudo-numbers often flicker and form, dissolve and reform in fractions of a second, all over my visual field. Sometimes, if I am looking at a horizontal segment of a wall, the runes come in a row, like a frieze.
Most of the time, I am able to ignore them, as I ignore the tinnitus I have had for the past few years. But often in the evening, when the sights and sounds of the day lessen, I may become suddenly aware of these faint hallucinations. And often it is a visual emptiness—a ceiling, a white washbasin, the sky—which makes me conscious of the visual patterns and images continually chasing across my visual field. Yet these little hallucinations are interesting, in a way: they show me the background activity, the idling, of my visual system, generating and transforming patterns, never at rest.
THURSDAY, DECEMBER 20, 2007
I had been feeling fairly relaxed about my tumor—it seemed relatively indolent and contained, and Dr. Abramson had said it was rare for ocular melanoma like mine to metastasize. But on Monday (the seventeenth, two years to the day since my tumor presented itself) I observed, in the gym, a roughly circular black spot the size of a dime on the skin just below my left shoulder. I was startled and frightened: the spot was jet black in color, with a clear border, and slightly raised; it looked nothing like an ordinary bruise.Was it, more ominously, the start of a skin melanoma, metastasized from the tumor in my eye?
When I showed the spot to Mark and Peter, who came for dinner tonight, both of them looked startled and worried. “It looks bad, very dark,” Mark said. “I think you should get it checked within twenty-four hours.” It did not, he added, look like a melanoma; but it did not look like anything he had ever seen before. Christmas holidays are upon us, as they were in ’05, and this means that I should get it looked at tomorrow; otherwise it may have to wait until the New Year. I fear I will obsess about it, get myself into a near panic, if this cannot be clarified straightaway. I feel agitated now . . . I think I may have to sedate myself.
FRIDAY, DECEMBER 21, 2007
The dermatologist, Dr. Bickers, a kind, sensitive man, very knowledgeable, too—realizing my anxiety, worked me into his schedule today. He looked at my arm and the rest of my skin, saw nothing amiss. The blackness, he said, was just a little bleeding into one of the brown spots that increasingly mottle one’s skin with age. Probably I had bumped into something; the blood would clear in a couple of days. I am greatly relieved—I would have gone mad waiting until January to have it checked.
For a decade or so before my melanoma, I had been an active member of the New York Stereoscopic Society; I had enjoyed playing with stereoscopes and stereo illusions since childhood. Seeing the world in depth always seemed as natural, as integral to my visual world as color vision. It gave me a sense of the solidity of objects and the reality of space—the wonderful, transparent medium in which they resided. I was keenly conscious of how my visual world instantly collapsed if I closed one eye and reexpanded the moment I opened it again. Like many of my fellow members of the Stereoscopic Society, I seemed to live in a deeper world, visually, than most people.
My experiences with Stereo Sue and her lyrical delight when she gained stereo vision after a lifetime of stereo blindness reinforced my feeling of appreciation for stereo vision. Indeed, I had spent much of 2004 and 2005 preoccupied with stereo vision, thinking and writing about it, and corresponding with Sue.
And then, in June of 2007, when the melanoma encroached on my fovea and had to be lasered, I lost all the central vision in that eye and, with it, stereoscopy. The complete and sudden flattening of the visual world I had experimented with as a boy by closing one eye now became a permanent condition. Some people have little stereo vision to begin with, or else they make so little use of binocular cues that they scarcely notice the difference if they lose stereoscopy. My situation was very different. Stereoscopy had been a central part of my visual life, and its loss had a profound impact at many levels, from the practical challenges of daily life to the whole concept of “space.” Indeed, these changes were so radical that I was slow to recognize them fully.
Stereoscopy is most important in one’s immediate vicinity, and it was here that I had initial problems of all sorts, some comic and some dangerous. When I reached out my hand for a canapé at a cocktail party, I might find myself grasping at air, missing the mark by six inches or more. I once poured wine into a friend’s lap, missing the glass by almost a foot.
More dangerously, I fail to see steps or curbs, and may trip or come down with a jolt. If there are no shadows or ancillary cues, I see steps only as lines on the ground and have no idea how deep they are, let alone whether they go up or down. Particularly treacherous are those I cannot anticipate, such as a couple of steps in an outdoor plaza or in someone’s sunken living room (often these also lack railings, which can serve as a visual cue). Going down a flight of stairs is a real and sometimes terrifying hazard, and I need to feel my way cautiously, testing for each step with my foot. Sometimes there may be such a compelling sense of flatness to my eye that it competes with what my foot says. Even when every other sense, including common sense, tells me that there is another step, if I cannot see its depth, I hesitate, confounded. After a long pause, I will trust my foot, but the dominating power of vision makes this far from easy.
These experiences (like many others in the past two years) set me to thinking of Edwin Abbott’s classic 1884 book Flatland, where the inhabitants of his two-dimensional world are themselves two-dimensional geometric figures. Occasionally they are confronted by spontaneous changes in the appearance of things which can only be explained, their theorists tell them, if one postulates the existence of three-dimensional objects moving in a three-dimensional space, presenting slices of themselves as they intersect the plane of Flatland. Thus Flatlanders infer the existence of a spatial dimension they cannot see. This is a far-fetched analogy to my own situation, but it always comes to mind when I have to infer depth, despite the at times overwhelming flatness presented to my eye.
Paradoxically, I have lost my fear of heights. I used to feel a sort of frisson, a slight sense of alarm, when I looked down from a tall building to the street below. When I lived in Topanga Canyon, I would avoid getting near the precipitous edges of the winding canyon road. The thought of falling gave me the chills. But now that I have lost depth perception, these feelings have disappeared, and I can look down from great heights with complete indifference.
Occasionally, I have pseudo-stereo experiences, as when something flat, like a newspaper lying on the floor, looks to me as if it is sticking up in the air. Opening my door, I have mistaken my doormat for a table and come to an abrupt, confounded halt. Sometimes I imagine that there may be steps when I see lines on the ground, the edge of a rug, or some other boundary. Does the boundary go with a step, or not? So I have to stop and carefully test with a toe. I rarely experienced such misperceptions when I had both eyes, for stereoscopy serves to clarify and disambiguate situations where monocular cues may be ambiguous or deceiving.
Crossing streets, dealing with steps, just walking around—things that needed no conscious attention before—now require constant care and forethought. People who have spent most of their lives without stereo vision, like Sue, may adapt relatively easily to these challenges, but having been exceptionally and perhaps excessively biased to binocular cues for stereoscopy, I was finding it extremely difficult to function without two eyes.
I wake every morning to a cluttered world, everything on top of everything else. There is no room anywhere, no space between things.
I used to enjoy the tiny light bulbs strung on city trees at Christmas—they seemed to create globes of twinkling lights suspended in midair. Now I see a tree full of such lights as a disk, with no more depth than a sky full of stars. And when I go to the botanic garden, I can no longer gaze, as I once loved to do, at the thick foliage of trees and bushes and see layer after layer, depth upon depth—it is all a flat confusion now.
My reflection in the mirror no longer seems to be behind the mirror; it appears on the same plane as the mirror’s surface. I see spots on my clothes in the mirror and try to brush them off, only to realize that they are spots on the surface of the mirror itself. A similar confusion made me think, one February day, that it was snowing inside the kitchen—“outside” the window seemed no farther away than “inside.”4
While, for the most part, I hate the flatness of everything and lament the loss of depth, I occasionally have a sense of appreciation for my two-dimensional world. Sometimes I see a room, a quiet street, or a laid table as a still life, a beautiful visual composition, as I imagine it might be seen by a painter or a photographer constrained to a flat canvas or film. I find a new pleasure in looking at paintings or photographs, now that I am more conscious of the art of composition. They can be more beautiful in this sense, although they no longer yield me even the illusion of depth.
One afternoon I went to a nearby Japanese restaurant for sushi—one of the attractions of my sidewalk table being the sight of a ginkgo tree across the road. In the middle of the day, at that time of year, the sun’s rays would cast a detailed shadow of the tree and its delicate leaves onto the yellow wall about five feet behind it. But, without stereoscopy, I now saw the tree and its shadow on the same plane, as if both were painted on the wall—a vision both alarming and exquisite, for the 3-D reality had turned into a Japanese painting.
Stereo vision at a distance may be less immediately important, but not being able to judge distance opens me to deep and often absurd doubts and illusions. In Edgar Allan Poe’s story “The Sphinx,” the narrator sees a gigantic jointed creature climbing a faraway hillside; only later does he realize that what he is seeing is a minute insect, practically in front of his nose. I found “The Sphinx” a little far-fetched until I lost stereoscopy. Now I have such experiences constantly. The other day I saw a piece of lint on my glasses and tried to clean it off, only to realize that the “lint” was a leaf on the sidewalk.
It is not just the sense of depth and distance which is undermined but, occasionally, the sense of perspective itself, so crucial to the recognition that one is in a world of solid objects arrayed in space. When I visited a friend’s barn on Long Island, I first failed to recognize it as a barn, for I saw only vertical, horizontal, and diagonal lines, like a geometrical diagram inscribed on the sky. Then, all of a sudden, it acquired perspective and became recognizable as a barn, though still flat, like a photograph or a painting.
My inability to see depth or distance leads me to combine or conflate near and far objects into strange hybrids or chimeras. One day I was puzzled to find a gray web between my fingers, before I realized that I was seeing the gray carpet three feet below—now seen on the same plane as my hands and construed as part of them. I was horrified once, looking at a friend in profile, to notice twigs or slivers of wood coming out of her eyes—but these belonged, I soon realized, to a tree across the road. I spotted a man crossing the road in Union Square, with an enormous scaffolding on his shoulders—he is crazy to be carrying such a thing, I thought—and then I realized that the scaffolding was thirty feet behind him, another conflation. Another time I saw the top of a fire engine apparently impaled on the roof of my car, and then realized that the fire engine was a dozen yards behind the car. But knowing this, or moving my head to demonstrate it by motion parallax, makes strangely little difference to the illusion.
A gigantic pontoon a hundred feet high, spotted at a traffic jam, turns out to be the side-view mirror of a car just in front of me. A woman’s strange green umbrella turns out to be a tree a hundred feet behind her. Most frighteningly, as I was reading in bed one night, I “saw” the ceiling fan about to crash into the reading light just above my head—I “know” that the two objects are at least four feet apart, but this did not prevent the sudden illusion.
Nothing protrudes or recedes from me anymore; there is no direct sensation of “before” or “behind,” only an inference based on occlusion and perspective. Space was once a hospitable, deep realm in which I could locate myself and wander at will. I could enter it, I lived in it, I had a spatial relationship to everything I could see. That sort of space no longer exists for me visually—or mentally.
After two years without stereoscopy, I now function pretty well. I have learned how to shake hands, pour wine, and negotiate steps. I have returned to bicycling and driving my car—these are made possible by motion parallax and the fact that perception is being complemented by action, that I am acting in a three-dimensional world, even though it still looks two-dimensional to me. Most of the time, I can “see through” my illusions and conflations. But this does not alter my sense that a fundamental aspect of the visual world has been taken away and that things will never look as they did before, will never look right. The visual reality I face is utterly wrong—for I know so well how things used to be, and should be.
The only time I see in stereo now is in dreams, for I have had occasional stereo dreams all my life—usually dreams in which I am looking through a stereoscope at an exquisite pair of stereo photographs, perhaps at an urban landscape or the depths of the Grand Canyon. I wake from these to a reality which is incorrigibly, irreversibly, maddeningly flat.
My vision remained in this state, fairly stable, for two years. I was able to do most of the things I wanted—for having peripheral vision in my right eye still allowed me a full visual field, even if it lacked straight-ahead depth. With this peripheral vision, I maintained a small crescent of stereopsis near the bottom of the visual field, and this was important in giving me some implicit or unconscious sense of depth and space, even if there was no stereopsis in the rest of the visual field. But it could be very tantalizing, too, for the region of stereopsis lay below my fixation point, and whenever I tried to focus on something with my one good eye, it immediately flattened out.5
All this was to change on September 27, 2009. The day opened like any other; I had my swim, ate breakfast, and was cleaning my teeth, when it seemed to me that a film came over my right eye. Its peripheral vision, the only vision it still had, was hazy. I wondered if my glasses had misted over, so I took them off and cleaned them—but the film was still there. I could see objects through it, but their outlines were indistinct.
“One of those things,” I thought (although it was unlike anything I had ever experienced before). “It will clear in a few minutes.” But it did not clear. It grew denser and denser. A feeling of fear and danger took hold of me—what was going on? I phoned Dr. Abramson’s office; he was away, but his colleague suggested that I come to the office straightaway. Looking into the eye, Dr. Marr confirmed my suspicion: there was bleeding, probably from the retina, and the blood was now seeping into the vitreous humor at the back of the eye. The cause of the hemorrhage was unclear, but the tumor, irradiation, and repeated laserings might well have scarred the retina, making it more fragile, increasing the chances of a blood vessel being eroded or giving way. There was nothing to be done at this point.
By late afternoon I could not count my own fingers or see anything distinctly with the right eye. I could only sense diffuse illumination from the window and some movement, the way one can see, in bright light, a hand waving in front of the eyes even when the eyelids are closed. The blood would eventually clear, I was told, but this could take six months or more—now, for all practical purposes, my right eye was completely blind.
I could not help thinking of that other day, the day everything started to go wrong, at the end of 2005—and of the nearly four-year fight in which the eye carried on, with ever more of the retina being nibbled at or blasted away. Was this the final knockout blow?
To take my mind off things visual, I went to the piano, closed my eyes, and played for a while. Then, to dull my feelings and prevent rumination, I took two sleeping tablets and went to bed.
I slept deeply. Awakened by my clock radio, I listened with my eyes closed, in that dreamy state between wake and sleep, and it was only when I opened my eyes and saw nothing with the right eye but a vague dim light where the morning sun was flooding in that the memory of what had happened suddenly came back to me.
On Monday morning, Kate came over and suggested that we go for a walk together. As soon as we emerged into the morning bustle of Greenwich Avenue, crowded with people balancing coffee cups and cell phones, people walking dogs, parents with children going to school, I realized that I was in trouble. I was startled, even terrified, because people and objects suddenly seemed to materialize, to loom at me on the right side without any warning. Had Kate not been walking on my right, protecting my blind side, I would have been colliding with everything, tripping over dogs, crashing into strollers, without the least awareness that they were there.
We do not honor our peripheral vision as much as we should, for most of the time we have little explicit consciousness of it. We look, we fixate, we target with our foveas, our central vision. But it is peripheral vision, surrounding this, which gives us a context, a sense of how whatever we are looking at is situated in the wider world. And it is especially movement that peripheral vision is tuned to: peripheral vision alerts us to unexpected movements on either side, and then central vision moves in to target these.
For me, now, a biggish slice of the periphery to my right—forty degrees or more, like a very large slice of cake—has been carved out of my vision. I see, roughly speaking, nothing to the right side of my nose.6 I had lost central vision in the eye earlier, but I still had enough peripheral vision to give me a forewarning, an intimation, of things happening on that side. But now I have lost even this. I have no awareness here, and whatever comes into my visual field from that side is unexpected and startling. I cannot overcome the sense of bewilderment, even shock, when people or objects appear suddenly to my right. A massive slice of space no longer exists for me, and the idea that there could be anything in that space has likewise disappeared.
Neurologists talk of “unilateral neglect” or “hemi-inattention,” but these technical terms do not convey how outlandish such a state can be. Years ago, I had a patient with a startling neglect of her own left side, and the left side of space, due to a stroke in her right parietal lobe.7 But this had not prepared me at all to find myself in a virtually identical situation (though caused, of course, not by a cerebral problem but by an ocular one). This came home even more forcefully when Kate and I finished our walk and headed back to my office. I walked ahead and got into the elevator—but Kate had vanished. I presumed she was talking to the doorman or checking the mail, and waited for her to catch up. Then a voice to my right—her voice—said, “What are we waiting for?” I was dumbfounded—not just that I had failed to see her to my right, but that I had even failed to imagine her being there, because “there” did not exist for me. “Out of sight, out of mind” is literally true in such a situation.
NOVEMBER 9, 2009
Six weeks have passed now since the hemorrhage. I had expected, in time, to accommodate to my semiblindness, my hemispace, but that has not happened. Every time someone or something suddenly appears to my right, it is just as unexpected as the first time. I am still in a world of suddenness and discontinuity, of sudden apparitions and disappearances.8
I can deal with this only by constantly turning my head to monitor what is going on in the blind area. (Indeed, I have to twist my entire upper body around to compensate for the sixty degrees or so I am missing.) But doing this is not only wearisome, it feels absurd, because so far as my own perception is concerned, I have a full visual field—nothing is missing for me, subjectively, and so there is nothing to look for. It may appear odd to other people, too, who feel that I am acting bizarrely, contorting my body or turning around and staring at them.
There are parallel experiences with senses other than vision. If one has a complete spinal anesthesia, for instance, one loses all sensation and power of movement in the lower half of the body. But this description does not do full justice to the strangeness one can encounter. One’s awareness, the sense of one’s body, is sharply terminated, in effect, at the level of the anesthetic, and what lies below is no longer felt as part of oneself, for it is not sending any information to the brain testifying to its own existence. It has disappeared, taking its place, its space with it.
One can, of course, look at one’s “missing” legs, and this is even stranger in a way, for the legs seem curiously unreal, alien—almost like wax models from an anatomy museum. It has been shown, with functional imaging, that the anesthetized parts of the body actually lose their representation in the sensory cortex. So it seems with the right side of my visual field—it no longer sends any signals to the brain, no longer has any representation there. As far as the brain is concerned, it does not exist.
DECEMBER 6, 2009
It is now ten weeks since my hemorrhage, and I have still achieved surprisingly little in the way of accommodation. I must remind myself again and again to check, to make sure that nothing on the blind side is being ignored or forgotten—it is still far from automatic. I wonder if I will ever accommodate, and I think of something one of my correspondents, Stephen Fox, wrote:
Far worse than the loss of depth was the new limitation on the visual field. My right arm became covered in bruises from running into door frames because my brain was still reacting as if it was getting the full panorama from two eyes. I also often knocked objects off the table with my right arm. In fact, limited scope remains a problem even after 22 years, especially in crowded subway stations where people’s paths may suddenly and silently converge on my right, resulting in occasional, embarrassing collisions.
Greenwich Avenue, and the outside world generally, remain as full of hazards, real and imaginary, as when I went for that first post-hemorrhage walk many weeks ago. People rush around, so preoccupied with cell phones and text messaging that they themselves are functionally deaf and blind, oblivious of their environment; others have tiny, insectlike dogs on long, invisible leashes, which function as trip wires for the visually impaired; children zip around beneath eye level on scooters. There are other dangers, too: manholes, grates, and fire hydrants, doors suddenly opening, cyclists delivering lunches—the entire scene seems designed to drum up business for orthopedists. I dare not walk alone; fortunately, my friends help out by walking with me, acting as guides and protectors on my blind side. And I would not dream of driving at this point.
I try to stick to the right side of the sidewalk so that no one can overtake me on my blind side, but this is not always possible: the sidewalk is often crowded and not mine to commandeer as I might like. I find myself losing things on my own desk—my reading glasses, my fountain pen, a letter I have just written—if I have placed them to my right.
And yet (so I am told, in Frank Brady’s book A Singular View: The Art of Seeing with One Eye) almost everyone who loses an eye does accommodate to its loss, more easily if they are young or if the loss of vision is gradual; especially too if the affected eye is not the dominant one and vision in the other eye is good. (I, alas, rank rather low on all these criteria.) Most people, given time, are able to return to a full and free life—so long, Brady emphasizes, as they retain a special mindfulness, a hyperconsciousness, of the missing side.
Perhaps this will be possible for me, too, in the future. But it is far from my situation now. Strange incidents seem to beset me all the while. Returning the other day from a walk with my friend Billy, I “lost” him when I entered the elevator. I turned to the right and someone was standing there, someone who I thought for a moment must be Billy. Then I realized that it was a stranger, a stranger who himself looked surprised and puzzled, even slightly alarmed, at my turning and staring at him with a look of befuddlement. He must have thought I was mad. It was only when I twisted still farther to the right that I found Billy, to the left of the stranger, deep in my nowhere.
Five minutes later, when we got to my apartment and I turned to put on a kettle for tea, Billy vanished again—but I discovered him, after a bewildered pause, precisely where I had left him. He had not moved, but my turning away had put him in my blind spot, my visual and mental “nowhere.” I was again astounded that this could happen within seconds, and in a way so contrary to memory and common sense. Each time this happens, it is just as startling.
Time will tell whether I am able to adapt to this new visual challenge—or perhaps the hemorrhage will clear first and restore at least some peripheral vision to my right eye. In the meantime, I have a large “nowhere” in my right visual field and my brain, a nowhere of which I am not and can never be directly conscious. For me, people and objects continue to “disappear into thin air” or “come out of the blue”—these are no longer just metaphors for me, but as close as I can come to describing the experience of nothingness and nowhere.
The Mind’s Eye
TO WHAT EXTENT are we the authors, the creators, of our own experiences? How much are these predetermined by the brains or senses we are born with, and to what extent do we shape our brains through experience? The effects of a profound perceptual deprivation such as blindness may cast an unexpected light on these questions. Going blind, especially later in life, presents one with a huge, potentially overwhelming challenge: to find a new way of living, of ordering one’s world, when the old way has been destroyed.
In 1990, I was sent an extraordinary book called Touching the Rock: An Experience of Blindness, by John Hull, a professor of religious education in England. Hull had grown up partly sighted, developing cataracts at the age of thirteen and becoming completely blind in his left eye four years later. Vision in his right eye remained reasonable until he was thirty-five or so, but there followed a decade of steadily failing vision, so that Hull needed stronger and stronger magnifying glasses and had to write with thicker and thicker pens. In 1983, at the age of forty-eight, he became completely blind.
Touching the Rock is the journal he dictated in the three years that followed. It is full of piercing insights about his transition to life as a blind person, but most striking for me was his description of how, after he became blind, he experienced a gradual attenuation of visual imagery and memory, and finally a virtual extinction of them (except in dreams)—a state that he called “deep blindness.”
By this, Hull meant not only a loss of visual images and memories but a loss of the very idea of seeing, so that even concepts like “here,” “there,” and “facing” seemed to lose meaning for him. The sense of objects having appearances, or visible characteristics, vanished. He could no longer imagine how the numeral 3 looked unless he traced it in the air with his finger. He could construct a motor image of a 3, but not a visual one.
At first Hull was greatly distressed by this: he could no longer conjure up the faces of his wife or children, or of familiar and loved landscapes and places. But he then came to accept it with remarkable equanimity, regarding it as a natural response to losing his sight. Indeed, he seemed to feel that the loss of visual imagery was a prerequisite for the full development, the heightening, of his other senses.
Two years after becoming completely blind, Hull had apparently become so nonvisual in his imagery and memory as to resemble someone who had been blind from birth. In a profoundly religious way, and in language sometimes reminiscent of that of Saint John of the Cross, Hull entered into the state of deep blindness, surrendered himself, with a sort of acquiescence and joy. He spoke of deep blindness as “an authentic and autonomous world, a place of its own. . . . Being a whole-body seer is to be in one of the concentrated human conditions.”
Being a “whole-body seer,” for Hull, meant shifting his attention, his center of gravity, to the other senses, and these senses assumed a new richness and power. Thus he wrote of how the sound of rain, never before accorded much attention, could delineate a whole landscape for him, for its sound on the garden path was different from its sound as it drummed on the lawn, or on the bushes in his garden, or on the fence dividing the garden from the road:
Rain has a way of bringing out the contours of everything; it throws a coloured blanket over previously invisible things; instead of an intermittent and thus fragmented world, the steadily falling rain creates continuity of acoustic experience . . . presents the fullness of an entire situation all at once . . . gives a sense of perspective and of the actual relationships of one part of the world to another.
With his new intensity of auditory experience (or attention), along with the sharpening of his other senses, Hull came to feel a sense of intimacy with nature, an intensity of being-in-the-world, beyond anything he had known when he was sighted. Blindness became for him “a dark, paradoxical gift.” This was not just “compensation,” he emphasized, but a whole new order, a new mode of human being. With this, he extricated himself from visual nostalgia, from the strain or falsity of trying to pass as “normal,” and found a new focus, a new freedom and identity. His teaching at the university expanded, became more fluent; his writing became stronger and deeper; he became intellectually and spiritually bolder, more confident. He felt he was on solid ground at last.1
Hull’s description seemed to me an astounding example of how an individual deprived of one form of perception could totally reshape himself to a new center, a new perceptual identity. Yet I found it extraordinary that such an annihilation of visual memory as he described could happen to an adult with decades of rich and significant visual experience to call upon. I could not, however, doubt the authenticity of Hull’s account, which he related with the most scrupulous care and lucidity.
Cognitive neuroscientists have known for the past few decades that the brain is far less hardwired than was once thought. Helen Neville was one of the pioneers here, showing that in prelingually deaf people (that is, those who had been born deaf or become deaf before the age of two or so) the auditory parts of the brain did not degenerate. They remained active and functional, but with an activity and a function that were new: they were transformed, “reallocated,” in Neville’s term, for processing visual language. Comparable studies in those born blind, or blinded early, show that some areas of the visual cortex may be reallocated and used to process sound and touch.
With this reallocation of parts of the visual cortex, hearing, touch, and other senses in the blind can take on a hyperacuity that perhaps no sighted person can imagine. Bernard Morin, the mathematician who showed in the 1960s how a sphere could be turned inside out, became blind at the age of six, from glaucoma. He felt that his mathematical achievement required a special sort of spatial sense—a haptic perception and imagination beyond anything a sighted mathematician was likely to have. And a similar sort of spatial or tactile giftedness has been central to the work of Geerat Vermeij, a conchologist who has delineated many new species of mollusks, based on tiny variations in the shapes and contours of their shells. Vermeij has been blind since the age of three.2
Faced with such findings and reports, neuroscientists began to concede in the 1970s that there might be a certain flexibility or plasticity in the brain, at least in the first couple of years of life. But when this critical period was over, it was thought, the brain became much less plastic.
Yet the brain remains capable of making radical shifts in response to sensory deprivation. In 2008, Lotfi Merabet, Alvaro Pascual-Leone, and their colleagues showed that, even in sighted adults, as little as five days of being blindfolded produced marked shifts to nonvisual forms of behavior and cognition, and they demonstrated the physiological changes in the brain that went along with this. (They feel it is important to distinguish between such rapid and reversible changes, which seem to make use of preexisting but latent intersensory connections, and the long-lasting changes that occur especially in response to early or congenital blindness, which may entail major reorganizations of cortical circuitry.)
Apparently Hull’s visual cortex, even in adulthood, had adapted to a loss of visual input by taking over other sensory functions—hearing, touch, smell—while relinquishing the power of visual imagery. I assumed that Hull’s experience was typical of acquired blindness, the response, sooner or later, of everyone who loses sight—and a brilliant example of cortical plasticity.
Yet when I came to publish an essay on Hull’s book in 1991, I was taken aback to receive a number of letters from blind people, letters that were often somewhat puzzled and occasionally indignant in tone. Many of these people wrote that they could not identify with Hull’s experience and said that they themselves, even decades after losing their sight, had never lost their visual images or memories. One woman, who had lost her sight at fifteen, wrote:
Even though I am totally blind . . . I consider myself a very visual person. I still “see” objects in front of me. As I am typing now I can see my hands on the keyboard. . . . I don’t feel comfortable in a new environment until I have a mental picture of its appearance. I need a mental map for my independent moving, too.
Had I been wrong, or at least one-sided, in accepting Hull’s experience as a typical response to blindness? Had I been guilty of emphasizing one mode of response too strongly, oblivious to other, radically different possibilities?
This feeling came to a head a few years later, when I received a letter from an Australian psychologist named Zoltan Torey. Torey wrote to me not about blindness but about a book he had written on the brain-mind problem and the nature of consciousness. In his letter he also mentioned that he had been blinded in an accident at the age of twenty-one. But although he was “advised to switch from a visual to an auditory mode of adjustment,” he had moved in the opposite direction, resolving to develop instead his inner eye, his powers of visual imagery, to their greatest possible extent.
In this, he said, he had been extremely successful, developing a remarkable power of generating, holding, and manipulating images in his mind, so much so that he had been able to construct a virtual visual world that seemed as real and intense to him as the perceptual one he had lost—indeed, sometimes more real, more intense. This imagery, moreover, enabled him to do things that might have seemed scarcely possible for a blind man.
“I replaced the entire roof guttering of my multigabled home single-handed,” he wrote, “and solely on the strength of the accurate and well-focused manipulation of my now totally pliable and responsive mental space.” Torey later expanded on this episode, mentioning the great alarm of his neighbors at seeing a blind man alone on the roof of his house—at night (even though, of course, darkness made no difference to him).
And he felt that his newly strengthened visual imagery enabled him to think in ways that had not been available to him before, allowed him to project himself inside machines and other systems, to envisage solutions, models, and designs.
I wrote back to Torey, suggesting that he consider writing another book, a more personal one, exploring how his life had been affected by blindness and how he had responded to this in the most improbable and seemingly paradoxical way. A few years later, he sent me the manuscript of Out of Darkness. In this new book, Torey described the early visual memories of his childhood and youth in Hungary before the Second World War: the sky-blue buses of Budapest, the egg-yellow trams, the lighting of gas lamps, the funicular railway on the Buda side. He described a carefree and privileged youth, roaming with his father in the wooded mountains above the Danube, playing games and pranks at school, growing up in a highly intellectual environment of writers, actors, professionals of every sort. Torey’s father was the head of a large motion-picture studio and would often give his son scripts to read. “This,” Torey wrote, “gave me the opportunity to visualize stories, plots and characters, to work my imagination—a skill that was to become a lifeline and source of strength in the years ahead.”
All of this came to a brutal end with the Nazi occupation, the siege of Buda, and then the Soviet occupation. Torey, by this time an adolescent, found himself passionately drawn to the big questions—the mystery of the universe, of life, and, above all, the mystery of consciousness, of the mind. At nineteen, feeling that he needed to immerse himself in biology, engineering, neuroscience, and psychology, but knowing that there was no chance of an intellectual life in Soviet Hungary, Torey made his escape and found his way to Australia, where, penniless and without connections, he did various manual jobs. In June of 1951, loosening the plug in a vat of acid at the chemical factory where he worked, he had the accident that bisected his life:
The last thing I saw with complete clarity was a glint of light in the flood of acid that was to engulf my face and change my life. It was a nano-second of sparkle, framed by the black circle of the drumface, less than a foot away. This was the final scene, the slender thread that ties me to my visual past.
When it became clear that his corneas had been hopelessly damaged and that he would have to live his life as a blind man, he was advised to rebuild his representation of the world on the basis of hearing and touch, and to “forget about sight and visualizing altogether.” But this was something that Torey could not or would not do. He had emphasized, in his first letter to me, the importance of a most critical choice at this juncture: “I immediately resolved to find out how far a partially sense-deprived brain could go to rebuild a life.” Put this way, it sounds abstract, like an experiment. But in his book one senses the tremendous feelings underlying his resolution: the horror of darkness—“the empty darkness,” as Torey often calls it, “the grey fog that was engulfing me”—and the passionate desire to hold on to light and sight, to maintain, if only in memory and imagination, a vivid and living visual world. The very title of his book says all this, and the note of defiance is sounded from the start.
Hull, who did not use his imagery in a deliberate way, lost it within two or three years and became unable to remember which way round a 3 went; Torey, on the other hand, soon became able to multiply four-figure numbers by each other, as on a blackboard, visualizing the whole operation in his mind, “painting” the suboperations in different colors.
Torey maintained a cautious and “scientific” attitude to his own visual imagery, taking pains to check the accuracy of his images by every means available. “I learned,” he wrote, “to hold the image in a tentative way, conferring credibility and status on it only when some information would tip the balance in its favor.” He soon gained enough confidence in the reliability of his visual imagery to stake his life upon it, as when he undertook roof repairs by himself. And this confidence extended to other, purely mental projects. He became able “to imagine, to visualize, for example, the inside of a differential gearbox in action as if from inside its casing. I was able to watch the cogs bite, lock and revolve, distributing the spin as required. I began to play around with this internal view in connection with mechanical and technical problems, visualizing how subcomponents relate in the atom, or in the living cell.” This power of imagery was crucial, Torey thought, in enabling him to arrive at a new view of the brain-mind problem by visualizing the brain “as a perpetual juggling act of interacting routines.”
Soon after receiving the manuscript of Out of Darkness, I received proofs of yet another memoir about blindness: Sabriye Tenberken’s My Path Leads to Tibet. While Hull and Torey are thinkers, preoccupied in their different ways by inwardness, states of brain and mind, Tenberken is a doer; she has traveled, often alone, all over Tibet, where for centuries blind people have been treated as less than human and denied education, work, respect, or a role in the community. Virtually single-handed, Tenberken has transformed their situation over the past decade or so, devising a form of Tibetan Braille, establishing the first schools for the blind there, and integrating the graduates of these schools into their communities.
Tenberken herself had impaired vision almost from birth, but was able to make out faces and landscapes until she was twelve. As a child in Germany, she loved painting and had a particular predilection for colors, and when she was no longer able to decipher shapes and forms, she could still use colors to identify objects.3
Though she had been totally blind for a dozen years when she went to Tibet, Tenberken continued to use her other senses, along with verbal descriptions, visual memories, and a strong pictorial and synesthetic sensibility, to construct “pictures” of landscapes and rooms, of environments and scenes—pictures so lively and detailed as to astonish her listeners. These images may sometimes be wildly or comically different from reality, as she related in one incident when she and a companion drove to Nam Co, the great salt lake in Tibet. Turning eagerly towards the lake, Tenberken saw, in her imagination, “a beach of crystallized salt shimmering like snow under an evening sun, at the edge of a vast body of turquoise water. . . . And down below, on the deep green mountain flanks, a few nomads were watching their yaks grazing.” It then turned out that she had not been “looking” at the lake at all, but facing in another direction, “staring” at rocks and a gray landscape. These disparities do not faze her in the least—she is happy to have so vivid a visual imagination. Hers is essentially an artistic imagination, which can be impressionistic, romantic, not veridical at all, whereas Torey’s imagination is that of an engineer, and has to be factual, accurate down to the last detail.
Jacques Lusseyran was a French Resistance fighter whose memoir, And There Was Light, deals mostly with his experiences fighting the Nazis and later in Buchenwald, but includes many beautiful descriptions of his early adaptations to blindness. He was blinded in an accident when he was not quite eight years old, an age that he came to feel was “ideal” for such an eventuality, for, while he already had a rich visual experience to call on, “the habits of a boy of eight are not yet formed, either in body or in mind. His body is infinitely supple.”
At first, Lusseyran began to lose his visual imagery:
A very short time after I went blind I forgot the faces of my mother and father and the faces of most of the people I loved. . . . I stopped caring whether people were dark or fair, with blue eyes or green. I felt that sighted people spent too much time observing these empty things. . . . I no longer even thought about them. People no longer seemed to possess them. Sometimes in my mind men and women appeared without heads or fingers.
This is similar to Hull, who wrote, “Increasingly, I am no longer even trying to imagine what people look like. . . . I am finding it more and more difficult to realize that people look like anything, to put any meaning into the idea that they have an appearance.”
But then, while relinquishing the actual visual world and many of its values and categories, Lusseyran began to construct and to use an imaginary visual world more like Torey’s. He came to identify himself as belonging to a special category, the “visual blind.”
Lusseyran’s inner vision started as a sensation of light, a formless, flooding, streaming radiance. Neurological terms are bound to sound reductive in this almost mystical context, yet one might venture to interpret this as a release phenomenon, a spontaneous, almost eruptive arousal of the visual cortex, now deprived of its normal visual input. (Such a phenomenon is analogous, perhaps, to tinnitus or phantom limbs, though endowed, here, by a devout and precociously imaginative little boy, with some element of the supernal.) But then, it becomes clear, he found himself in possession of great powers of visual imagery, and not just a formless luminosity.
The visual cortex, the inner eye, having been activated, his mind constructed a “screen” upon which whatever he thought or desired was projected and, if need be, manipulated, as on a computer screen. “This screen was not like a blackboard, rectangular or square, which so quickly reaches the edge of its frame,” he wrote.
My screen was always as big as I needed it to be. Because it was nowhere in space it was everywhere at the same time. . . . Names, figures and objects in general did not appear on my screen without shape, nor just in black and white, but in all the colors of the rainbow. Nothing entered my mind without being bathed in a certain amount of light. . . . In a few months my personal world had turned into a painter’s studio.
Great powers of visualization were crucial to the young Lusseyran, even in something as nonvisual (one would think) as learning Braille, and in his brilliant successes at school. Visualization was no less crucial in the real, outside world. Lusseyran described walks with his sighted friend Jean, and how, as they were climbing together up the side of a hill above the Seine Valley, he could say to Jean:
“Just look! This time we’re on top. . . . You’ll see the whole bend of the river, unless the sun gets in your eyes!” Jean was startled, opened his eyes wide and cried: “You’re right.” This little scene was often repeated between us, in a thousand forms.
Every time someone mentioned an event, the event immediately projected itself in its place on the screen, which was a kind of inner canvas. . . . Comparing my world with his, [Jean] found that his held fewer pictures and not nearly as many colors. This made him almost angry. “When it comes to that,” he used to say, “which one of us two is blind?”
It was his supernormal powers of visualization and visual manipulation—visualizing people’s positions and movements, the topography of any space, visualizing strategies for defense and attack—coupled with his charismatic personality (and seemingly infallible “nose” or “ear” for detecting possible traitors) that later made Lusseyran an icon in the French Resistance.
I had now read four memoirs, all strikingly different in their depictions of the visual experience of blinded people: Hull with his acquiescent descent into “deep blindness”; Torey with his “compulsive visualization” and meticulous construction of an internal visual world; Tenberken with her impulsive, almost novelistic visual freedom, along with her remarkable and specific gift of synesthesia; and Lusseyran, who identified himself as one of the “visual blind.” Was there any such thing, I wondered, as a typical blind experience?
Dennis Shulman, a clinical psychologist and psychoanalyst who lectures on biblical topics, is an affable, stocky, bearded man in his fifties who gradually lost his sight in his teens, becoming completely blind by the time he entered college. When we met a few years ago, he told me that his experience was completely unlike Hull’s:
I still live in a visual world after thirty-five years of blindness. I have very vivid visual memories and images. My wife, whom I have never seen—I think of her visually. My kids, too. I see myself visually—but it is as I last saw myself, when I was thirteen, though I try hard to update the image. I often give public lectures, and my notes are in Braille; but when I go over them in my mind, I see the Braille notes visually—they are visual images, not tactile.
Arlene Gordon, a former social worker in her seventies, told me that things were very similar for her. She said, “I was stunned when I read [Hull’s book]. His experiences are so unlike mine.” Like Dennis, she still identifies herself in many ways as a visual person. “I have a very strong sense of color,” she said. “I pick out my own clothes. I think, ‘Oh, that will go with this or that,’ once I have been told the colors.” Indeed, she was dressed very smartly, and took obvious pride in her appearance.
She still had a great deal of visual imagery, she continued: “If I move my arms back and forth in front of my eyes, I see them, even though I have been blind for more than thirty years.” It seemed that moving her arms was immediately translated into a visual image. Listening to talking books, she added, made her eyes ache if she listened too long; she felt herself to be “reading” at such times, the sound of the spoken words being transformed to lines of print on a vividly visualized book in front of her.4
Arlene’s comment reminded me of Amy, a patient who had been deafened by scarlet fever at the age of nine but was so adept a lip-reader that I often forgot she was deaf. Once, when I absentmindedly turned away from her as I was speaking, she said sharply, “I can no longer hear you.”
“You mean you can no longer see me,” I said.
“You may call it seeing,” she answered, “but I experience it as hearing.”
Amy, though totally deaf, still constructed the sound of speech in her mind. Both Dennis and Arlene, similarly, spoke not only of a heightening of visual imagery and imagination since losing their eyesight but also of what seemed to be a much readier transference of information from verbal description—or from their own sense of touch, movement, hearing, or smell—into a visual form. On the whole, their experiences seemed quite similar to Torey’s, even though they had not systematically exercised their powers of visual imagery the way he had, or consciously tried to make an entire virtual world of sight.
What happens when the visual cortex is no longer limited or constrained by any visual input? The simple answer is that, isolated from the outside, the visual cortex becomes hypersensitive to internal stimuli of all sorts: its own autonomous activity; signals from other brain areas—auditory, tactile, and verbal areas; and thoughts, memories, and emotions.
Torey, unlike Hull, played a very active role in building up his visual imagery, took control of it the moment the bandages were removed. Perhaps this was because he was already very at home with visual imagery, and used to manipulating it in his own way. We know that Torey was very visually inclined before his accident, and skilled from boyhood in creating visual narratives based on the film scripts his father gave him. (We have no such information about Hull, for his journal entries start only when he has become blind.)
Torey required months of intense cognitive discipline dedicated to improving his visual imagery, making it more tenacious, more stable, more malleable, whereas Lusseyran seemed to do this almost from the start. Perhaps this was because Lusseyran was not yet eight when blinded (while Torey was twenty-one), and his brain was, accordingly, more able to adapt to a new and drastic contingency. But adaptability does not end with youth. It is clear that Arlene, who became blind in her forties, was able to adapt in quite radical ways, too, developing the ability to “see” her hands moving before her, to “see” the words of books read to her, to construct detailed visual images from verbal descriptions. One has a sense that Torey’s adaptation was largely shaped by conscious motive, will, and purpose; that Lusseyran’s was shaped by overwhelming physiological disposition; and that Arlene’s lies somewhere in between. Hull’s, meanwhile, remains enigmatic.
How much do these differences reflect an underlying predisposition independent of blindness? Do sighted people who are good visualizers, who have strong visual imagery, maintain or even enhance their powers of imagery if they become blind? Do people who are poor visualizers, on the other hand, tend to move towards “deep blindness” or hallucinations if they lose their sight? What is the range of visual imagery in the sighted?
I first became conscious of great variations in the power of visual imagery and visual memory when I was fourteen or so. My mother was a surgeon and comparative anatomist, and I had brought her a lizard’s skeleton from school. She gazed at this intently for a minute, turning it round in her hands, then put it down and without looking at it again did a number of drawings of it, rotating it mentally by thirty degrees each time, so that she produced a series, the last drawing exactly the same as the first. I could not imagine how she had done this. When she said that she could see the skeleton in her mind just as clearly and vividly as if she were looking at it, and that she simply rotated the image through a twelfth of a circle each time, I felt bewildered, and very stupid. I could hardly see anything with my mind’s eye—at most, faint, evanescent images over which I had no control.5
My mother had hoped I would follow in her footsteps and become a surgeon, but when she realized how lacking in visual powers I was (and how clumsy, lacking in mechanical skill, too) she resigned herself to the idea that I would have to specialize in something else.
A few years ago, at a medical conference in Boston, I spoke about Torey’s and Hull’s experiences of blindness, how “enabled” Torey seemed to be by the powers of visualization he had developed, and how “disabled” Hull was—in some ways, at least—by the loss of his powers of visual imagery and memory. After my talk, a man in the audience came up to me and asked how well, in my estimation, sighted people could function if they had no visual imagery. He went on to say that he had no visual imagery whatever, at least none that he could deliberately evoke, and that no one in his family had any, either. Indeed, he had assumed this was the case with everyone until, as a student at Harvard, he had come to participate in some psychological tests and had realized that he apparently lacked a mental power that all the other students, in varying degrees, had.
“And what do you do?” I asked him, wondering what this poor man could do.
“I am a surgeon,” he replied. “A vascular surgeon. An anatomist, too. And I design solar panels.” But how, I asked him, did he recognize what he was seeing?
“It’s not a problem,” he answered. “I guess there must be representations or models in the brain that get matched up with what I am seeing and doing. But they are not conscious. I cannot evoke them.”
This seemed to be at odds with my mother’s experience—she, clearly, did have extremely vivid and readily manipulable visual imagery, though (it now seemed) this may have been a bonus, a luxury, and not a prerequisite for her career as a surgeon.
Is this also the case with Torey? Is his greatly developed visual imagery, though clearly a source of much pleasure, not as indispensable as he takes it to be? Might he, in fact, have been able to do everything he did, from carpentry to roof repair to making a model of the mind, without any conscious imagery at all? He himself raises this question.
The role of mental imagery in thinking was explored by Francis Galton in his 1883 book Inquiries into Human Faculty and Its Development. (Galton, a cousin of Darwin’s, was irrepressible and wide-ranging, and his book includes chapters on subjects as various as fingerprints, eugenics, dog whistles, criminality, twins, synesthesia, psychometric measures, and hereditary genius.) His inquiry into voluntary visual imagery took the form of a questionnaire, with such questions as “Can you recall with distinctness the features of all near relations and many other persons? Can you at will cause your mental image . . . to sit, stand, or turn slowly around? Can you . . . see it with enough distinctness to enable you to sketch it leisurely (supposing yourself able to draw)?” The vascular surgeon would have been hopeless on such tests—indeed, it was questions such as these that had floored him when he was a student at Harvard. And yet, finally, how much had it mattered?
As to the significance of such imagery, Galton is ambiguous and guarded. He suggests, in one breath, that “scientific men, as a class, have feeble powers of visual representation” and, in another, that “a vivid visualizing faculty is of much importance in connection with the higher processes of generalized thoughts.” He feels that “it is undoubtedly the fact that mechanicians, engineers and architects usually possess the faculty of seeing mental images with remarkable clearness and precision” but adds, “I am, however, bound to say, that the missing faculty seems to be replaced so serviceably by other modes of conception . . . that men who declare themselves entirely deficient in the power of seeing mental pictures can nevertheless give lifelike descriptions of what they have seen, and can otherwise express themselves as if they were gifted with a vivid visual imagination. They can also become painters of the rank of Royal Academicians.”
A mental image, for Galton, was picturing a familiar person or place in the mind’s eye; it was a reproduction or reconstruction of an experience. But there are also mental images of a much more abstract and visionary kind, images of something which has never been seen by the physical eye but which can be conjured up by the creative imagination and serve as models for investigating reality.6
In his book Image and Reality: Kekulé, Kopp, and the Scientific Imagination, Alan Rocke brings out the crucial role of such images or models in the creative lives of scientists, especially nineteenth-century chemists. He focuses especially on August Kekulé and the famous reverie, while he was riding a London bus, that led him to visualize the structure of a benzene molecule, a concept that would revolutionize chemistry. Although chemical bonds are invisible, they were as real to Kekulé, as visually imaginable, as the lines of force around a magnet were for Faraday. Kekulé said of himself that he had “an irresistible need for visualization.”
Indeed, a conversation about chemistry can hardly be maintained without such images and models, and in Mindsight, the philosopher Colin McGinn writes, “Images are not just minor variations on perception and thought, of negligible theoretical interest; they are a robust mental category in need of independent investigation. . . . Mental images . . . should be added as a third great category . . . to the twin pillars of perception and cognition.”
Some people, like Kekulé, are clearly very powerful visualizers in this abstract sense, but most of us use some combination of experiential visualization (imaging one’s house, for example) and abstract visualization (imagining the structure of an atom). Temple Grandin, though, feels she is a different sort of visualizer.7 She thinks entirely in terms of literal images she has seen before, as if she is looking at a familiar photograph or a film running in her head. When she imagines the concept of “heaven,” for instance, her instant association is to the film Stairway to Heaven, and the image in her mind is that of a staircase ascending into the clouds. If someone remarks that it is a rainy day, she sees, in her mind’s eye, the same “photograph” of rain, her own literal and iconic representation of rain. Like Torrey, she is a powerful visualizer; her extremely accurate visual memory allows her to walk through, in her mind, a factory she is designing, noting structural details even before it is built. Growing up, she assumed this was how everyone thought, and she is puzzled, now, by the idea that some people cannot summon visual images at will. When I told her I could not do so, she asked, “How do you think, then?”
When I talk to people, blind or sighted, or when I try to think of my own internal representations, I find myself uncertain whether words, symbols, and images of various types are the primary tools of thought or whether there are forms of thought antecedent to all of these, forms of thought essentially amodal. Psychologists have sometimes spoken of “interlingua” or “mentalese,” which they conceive to be the brain’s own language, and Lev Vygotsky, the great Russian psychologist, used to speak of “thinking in pure meanings.” I cannot decide whether this is nonsense or profound truth—it is the sort of reef I end up on when I think about thinking.
Galton himself was puzzled about visual imagery: it had an enormous range, and although it sometimes seemed an essential part of thinking, at other times it seemed irrelevant. This uncertainty has characterized the debate over mental imagery ever since. A contemporary of Galton’s, the early experimental psychologist Wilhelm Wundt, guided by introspection, believed imagery to be an essential part of thought. Others maintained that thinking was imageless and consisted entirely of analytical or descriptive propositions, and behaviorists did not believe in thinking at all—there was only “behavior.” Was introspection alone a reliable method of scientific observation? Could it yield data that were consistent, repeatable, measurable? It was only in the early 1970s that this challenge was faced by a new generation of psychologists. Roger Shepard and Jacqueline Metzler asked subjects to perform mental tasks that required rotating an image of a geometrical figure in their minds—the sort of imaginary rotation my mother performed when she drew the lizard’s skeleton from memory. They were able to determine in these first quantitative experiments that rotating an image took a specific amount of time—an amount proportional to the degree of rotation. Rotating an image through sixty degrees, for instance, took twice as long as rotating it through thirty degrees, and rotating it through ninety degrees, three times as long. Mental rotation had a rate, it was continuous and steady, and it took effort, like any voluntary act.
Stephen Kosslyn entered the subject of visual imagery from another angle, and in 1973 published a seminal paper contrasting the performance of “imagers” and “verbalizers” who were asked to remember a set of drawings they had been shown. Kosslyn hypothesized that if internal images were spatial and organized like pictures, the “imagers” ought to be able to focus selectively on a part of the image, and that time would be required for them to shift their attention from one part of the image to another. The time required, he thought, would be proportional to the distance the mind’s eye had to travel.
Kosslyn was able to show that all of these were indeed the case, indicating that visual images were essentially spatial and organized in space like pictures. His work has proved immensely fertile, but the ongoing debate about the role of visual imagery continues, as Zenon Pylyshyn and others have maintained that the mental rotation of images and “scanning” them could be interpreted as the result of purely abstract, nonvisual operations in the mind/brain.8
By the 1990s, Kosslyn and others were able to combine imagery experiments with PET and fMRI scanning, which allowed them to map the areas of the brain involved as people engaged in tasks requiring mental imagery. Mental imagery, they found, activated many of the same areas of the visual cortex as perception itself, showing that visual imagery was a physiological reality as well as a psychological one, and used at least some of the same neural pathways as visual perception.9
That perception and imagery share a common neural basis in the visual parts of the brain is suggested by clinical studies, too. In 1978 Eduardo Bisiach and Claudio Luzzatti in Italy related the cases of two patients who both developed a hemianopia following a stroke and could not see to the left side. When they were asked to imagine themselves walking down a familiar street and describe what they saw, they mentioned only the shops on the right side of the street; but when they were then asked to imagine turning around and walking back, they described the shops they had not “seen” before, the shops that were now on the right side. These beautifully examined cases showed that a hemianopia might cause not only a bisection of the visual field but a bisection of visual imagery as well.
Such clinical observations on the parallels between visual perception and visual imagery go back at least a century. In 1911, the English neurologists Henry Head and Gordon Holmes examined a number of patients with subtle damage to the occipital lobes—damage that led not to total blindness but to blind spots within the visual field. They found, by questioning their patients carefully, that blind spots in exactly the same locations occurred in the patients’ mental imagery as well. And in 1992, Martha Farah et al. reported that in a patient who lost partial vision on one side due to an occipital lobectomy, the visual angle of his mind’s eye was also reduced, in a way that perfectly matched his perceptual loss.
For me, the most convincing demonstration that at least some aspects of visual imagery and visual perception might be inseparable occurred when I was consulted in 1986 by Mr. I., an artist who became completely colorblind following a head injury.10 Mr. I. was distressed by his sudden inability to perceive colors, but even more by his total inability to evoke them in memory or imagery. Even his occasional visual migraines were now drained of color. Patients like Mr. I. suggest that the coupling of perception and imagery is very close in the higher parts of the visual cortex.11
Sharing characteristics and even sharing neural areas or mechanisms is one thing, but Kosslyn and others go further than this, suggesting that visual perception depends on visual imagery, matching what the eye sees, the retina’s output, with memory images in the brain. Visual recognition, they feel, could not occur without such matching. Kosslyn proposes, furthermore, that mental imagery may be crucial in thought itself—problem solving, planning, designing, theorizing. Support for this comes from studies asking subjects to answer questions that would seem to require visual imagery—for example, “Which is darker green, a frozen pea or a pine tree?” or “What shape are Mickey Mouse’s ears?” or “In which hand does the Statue of Liberty hold her torch?”—or asking them to solve problems that can be worked out either by means of imagery or by means of more abstract, nonvisual thinking. Kosslyn speaks here of a doubleness in the way people think, contrasting the use of “depictive” representations, which are direct and unmediated, with “descriptive” ones, which are analytic and mediated by verbal or other symbols. Sometimes, he suggests, one mode will be favored over another, depending on the individual and on the problem to be solved. Sometimes both modes will proceed in tandem (although depiction is likely to outpace description), and at other times one may start with depiction—images—and proceed to a purely verbal or mathematical representation.12
What, then, of people like me, or the vascular surgeon in Boston who cannot evoke any visual images voluntarily? One must infer, as my colleague in Boston does, that we, too, have visual images, models, and representations in the brain, images that allow visual perception and recognition but are below the threshold of consciousness.13
If the central role of visual imagery is to permit visual perception and recognition, what need is there for it if a person becomes blind? And what happens to its neural substrates, the visual areas which occupy nearly half of the entire cerebral cortex? We know that in adults who lose their eyesight, there may be some atrophy of the pathways and relay centers leading from the retina to the cerebral cortex—but there is little degeneration in the visual cortex itself. Functional MRIs of the visual cortex show no diminution of activity in such a situation; indeed, we see the reverse: they reveal a heightened activity and sensitivity. The visual cortex, deprived of visual input, is still good neural real estate, available and clamoring for a new function. In someone like Torey, this may free up more cortical space for visual imagery; in someone like Hull, relatively more may be employed by other senses—auditory perception and attention, perhaps, or tactile perception and attention.14
This sort of cross-modal activation may underlie the fact that some blind people, like Dennis Shulman, “see” Braille as they read it with their finger. This may be more than just an illusion or a fanciful metaphor; it may be a reflection of what is actually happening in his brain, for there is good evidence that reading Braille can cause strong activation of the visual parts of the cortex, as Sadato, Pascual-Leone, et al. have reported. Such activation, even in the absence of any input from the retina, may constitute a crucial part of the neural basis for the mind’s eye.
Dennis also spoke of how the heightening of his other senses had increased his sensitivity to the most delicate nuances in other people’s speech and self-presentation. He could recognize many of his patients by smell, he said, and he could often pick up states of tension or anxiety they might not even be aware of. He felt that he had become far more sensitive to others’ emotional states since losing his sight, for he was no longer taken in by visual appearances, which most people learn to camouflage. Voices and smells, by contrast, he felt, could reveal people’s depths.
The heightening of other senses with blindness allows a number of very remarkable adaptations, including “facial vision,” the ability to use sound or tactile clues to sense the shape or size of a space and the people or objects in it.
Martin Milligan, the philosopher, who had both eyes removed at the age of two (because of malignant tumors), has written of his own experience:
Born-blind people with normal hearing don’t just hear sounds: they can hear objects (that is, have an awareness of them, chiefly through their ears) when they are fairly close at hand, provided these objects are not too low; and they can also in the same way “hear” something of the shape of their immediate surroundings. . . . Silent objects such as lamp-posts and parked cars with their engines off can be heard by me as I approach them and pass them as atmosphere-thickening occupants of space, almost certainly because of the way they absorb and/or echo back the sounds of my footsteps and other small sounds. . . . It isn’t usually necessary to make sounds oneself to have this awareness, though it helps. Objects of head height probably slightly affect the air currents reaching my face, which helps towards my awareness of them—which is why some blind people refer to this kind of sense-awareness as their “facial” sense.
Facial vision tends to be most highly developed in those who are born blind or lose their sight at an early age; for the writer Ved Mehta, who has been blind since the age of four, it is so well developed that he walks confidently and rapidly without a cane, and it is sometimes difficult for others to realize that he is blind.
While the sound of one’s footsteps or one’s cane may suffice, other forms of echolocation have been reported. Ben Underwood developed an astonishing, dolphinlike strategy of emitting regular clicks with his mouth and accurately reading the resulting echoes from nearby objects. He was so adept at moving about the world in this way that he was able to play field sports and even chess.15
Blind people often say that using a cane enables them to “see” their surroundings, as touch, action, and sound are immediately transformed into a “visual” picture. The cane acts as a sensory substitution or extension. But is it possible to give a blind person a more detailed picture of the world, using more modern technology? Paul Bach-y-Rita was a pioneer in this realm and spent decades testing all sorts of sensory substitutes, though his special interest lay in developing devices that could help the blind by using tactile images. (In 1972, he published a prescient book surveying all the possible brain mechanisms by which sensory substitution might be realized. Such substitution, he emphasized, would depend on the brain’s plasticity—and that the brain had any plasticity at all was a revolutionary concept at the time.)
Bach-y-Rita wondered if one might connect the output of a video camera, point by point, to the skin, allowing a blind subject to form a “touch picture” of his environment. This might work, he thought, because tactile information is organized topographically in the brain, and topographic accuracy is essential for forming a quasi-visual picture. Eventually, he began using tiny grids of a hundred or so electrodes on that most sensitive part of the body, the tongue. (The tongue has the highest density of sensory receptors in the body, and it also occupies the greatest amount of space, proportionally, in the sensory cortex. This makes it uniquely suitable for sensory substitution.) With this device, the size of a postage stamp, his subjects could form a crude but nevertheless useful “picture” on the tongue itself.
Over the years, the sophistication of such devices has increased greatly, and prototypes now have four to six times the resolution of Bach-y-Rita’s early version. Bulky camera cables have been replaced by spectacles containing miniature cameras, allowing subjects to direct the cameras by a more natural head movement. With this, blind subjects are able to walk across a room that is not too cluttered, or to catch a ball rolled towards them.
Does this mean that they are now “seeing”? Certainly, they are showing what behaviorists would call “visual behavior.” Bach-y-Rita spoke of how his subjects “learn[ed] to make perceptual judgements using visual means of interpretation, such as perspective, parallax, looming and zooming, and depth estimates.” Many of these people felt as if they were seeing once again, and functional MRIs showed strong activations of visual areas in their brains while they were “seeing” with the camera. (“Seeing” occurred particularly when the subjects were able to move the camera voluntarily, pointing it here or there, looking with it. Looking was crucial, for there is no perception without action, no seeing without looking.)
To restore sight to someone who once had it, whether by surgical means or by a sensory-substitution device, is one thing, for such a person would have an intact visual cortex and a lifetime of visual memories. But to give sight to someone who has never seen, never experienced light or sight, would seem to be impossible, in view of what we know about the brain’s critical periods and the necessity of at least some visual experience in the first two years of life to stimulate the development of the visual cortex. (Recent work from Pawan Sinha and others, however, suggests that the critical period may not be as critical as previously accepted.)16 Tongue vision has been tried with congenitally blind people, too, and with some success. One young musician, born blind, said she “saw” the conductor’s gestures for the first time in her life.17 Although the visual cortex in congenitally blind people is reduced in volume by more than 25 percent, it can still, apparently, be activated by sensory substitution, and this has been confirmed, in several cases, by fMRIs.18
There is increasing evidence for the extraordinarily rich interconnectedness and interactions of the sensory areas of the brain, and the difficulty, therefore, of saying that anything is purely visual or purely auditory, or purely anything. The world of the blind can be especially rich in such in-between states—the intersensory, the metamodal—states for which we have no common language.19
On Blindness is an exchange of letters between the blind philosopher Martin Milligan and a sighted philosopher, Bryan Magee. While his own nonvisual world seems coherent and complete to him, Milligan realizes that sighted people have access to a sense, a mode of knowledge, denied him. But congenitally blind people, he insists, can (and usually do) have rich and varied perceptual experiences, mediated by language and by imagery of a nonvisual sort. Thus they may have a “mind’s ear” or a “mind’s nose.” But do they have a mind’s eye?
Here Milligan and Magee cannot reach agreement. Magee insists that Milligan, a blind man, cannot have any real knowledge of the visual world. Milligan disagrees and maintains that even though language only describes people and events, it can sometimes stand in for direct experience or acquaintance.
Congenitally blind children, it has often been noted, tend to have superior memories and be precocious verbally. They may develop such fluency in the verbal description of faces and places as to leave others (and perhaps themselves) uncertain as to whether they are actually blind. Helen Keller’s writing, to give a famous example, startles one with its brilliantly visual quality.
I loved reading Prescott’s Conquest of Mexico and Conquest of Peru as a boy, and felt that I “saw” these lands through his intensely visual, almost hallucinogenic descriptions. I was amazed to discover, years later, that Prescott had not only never visited Mexico or Peru; he had been virtually blind since the age of eighteen. Did he, like Torey, compensate for his blindness by developing huge powers of visual imagery, or were his brilliant visual descriptions simulated, in a way, made possible by the evocative and pictorial powers of language? To what extent can description, picturing in words, provide a substitute for actual seeing or for the visual, pictorial imagination?
After becoming blind in her forties, Arlene Gordon found language and description increasingly important; it stimulated her powers of visual imagery as never before and, in a sense, enabled her to see. “I love traveling,” she told me. “I saw Venice when I was there.” She explained how her traveling companions would describe places, and she would then construct a visual image from these details, her reading, and her own visual memories. “Sighted people enjoy traveling with me,” she said. “I ask them questions, then they look and see things they wouldn’t otherwise. Too often people with sight don’t see anything! It’s a reciprocal process—we enrich each other’s worlds.”
There is a paradox here—a delicious one—which I cannot resolve: if there is indeed a fundamental difference between experience and description, between direct and mediated knowledge of the world, how is it that language can be so powerful? Language, that most human invention, can enable what, in principle, should not be possible. It can allow all of us, even the congenitally blind, to see with another person’s eyes.
BIBLIOGRAPHY
Abbott, Edwin A. 1884. Flatland: A Romance of Many Dimensions. Reprint, New York: Dover, 1992.
Aguirre, Geoffrey K., and Mark D’Esposito. 1997. Environmental knowledge is subserved by separable dorsal/ventral neural areas. Journal of Neuroscience 17 (7): 2512–18.
Bach-y-Rita, Paul. 1972. Brain Mechanisms in Sensory Substitution. New York: Academic Press.
Bach-y-Rita, Paul, and Stephen W. Kercel. 2003. Sensory substitution and the human-machine interface. Trends in Cognitive Sciences 7 (12): 541–46.
Barry, Susan R. 2009. Fixing My Gaze: A Scientist’s Journey into Seeing in Three Dimensions. New York: Basic Books.
Benson, D. Frank, R. Jeffrey Davis, and Bruce D. Snyder. 1988. Posterior cortical atrophy. Archives of Neurology 45 (7): 789–93.
Benson, D. Frank, and Norman Geschwind. 1969. The alexias. In Handbook of Clinical Neurology, vol. 4, ed. P. J. Vinken and G. W. Bruyn, pp. 112–40. Amsterdam: Elsevier.
Benton, Arthur L. 1964. Contributions to aphasia before Broca. Cortex 1: 314–27.
Berker, Ennis Ata, Ata Husnu Berker, and Aaron Smith. 1986. Translation of Broca’s 1865 report: localization of speech in the third left frontal convolution. Archives of Neurology 43: 1065–72.
Bértolo, H. 2005. Visual imagery without visual perception? Psicológica 26: 173–88.
Bértolo, H., T. Paiva, L. Pessoa, T. Mestre, R. Marques, and R. Santos. 2003. Visual dream content, graphical representation and EEG alpha activity in congenitally blind subjects. Brain Research/Cognitive Brain Research 15 (3): 277–84.
Beversdorf, David Q., and Kenneth M. Heilman. 1998. Progressive ventral posterior cortical degeneration presenting as alexia for music and words. Neurology 50: 657–59.
Bigley, G. Kim, and Frank R. Sharp. 1983. Reversible alexia without agraphia due to migraine. Archives of Neurology 40: 114–15.
Bisiach, E., and C. Luzzatti. 1978. Unilateral neglect of representational space. Cortex 14 (1): 129–33.
Bodamer, Joachim. 1947. Die Prosop-agnosie. Archiv für Psychiatrie und Nervenkrankheiten 179: 6–53.
Borges, Jorge Luis. 1984. Memories of a trip to Japan. In Twenty-four Conversations with Borges, ed. Roberto Alifano. Housatonic, MA: Lascaux Publishers.
Brady, Frank B. 2004. A Singular View: The Art of Seeing with One Eye. 6th ed. Vienna, VA: Michael O. Hughes.
Brewster, David. 1856. The Stereoscope: Its History, Theory and Construction. London: John Murray
Campbell, Ruth. 1992. Face to face: interpreting a case of developmental prosopagnosia. In Mental Lives: Case Studies in Cognition, ed. Ruth Campbell, pp. 216–36. Oxford: Blackwell.
Changizi, Mark. 2009. The Vision Revolution. Dallas: BenBella Books.
Changizi, Mark A., Qiong Zhang, Hao Ye, and Shinsuke Shimojo. 2006. The structures of letters and symbols throughout human history are selected to match those found in objects in natural scenes. American Naturalist 167 (5): E117–39.
Charcot, J. M. 1889. Clinical Lectures on Diseases of the Nervous System. Vol. III, contains Lecture XI, “On a case of wordblindness,” and Lecture XIII, “On a case of sudden and isolated suppression of the mental vision of signs and objects (forms and colours).” London: New Sydenham Society.
Chebat, Daniel-Robert, Constant Rainville, Ron Kupers, and Maurice Ptito. 2007. Tactile-“visual” acuity of the tongue in early blind individuals. NeuroReport 18: 1901–04.
Cisne, John. 2009. Stereoscopic comparison as the long-lost secret to microscopically detailed illumination like the Book of Kells. Perception 38 (7): 1087–1103.
Cohen, Leonardo G., Pablo Celnik, Alvaro Pascual-Leone, Brian Corwell, Lala Faiz, James Dambrosia, Manabu Honda, Norihiro Sadato, Christian Gerloff, M. Dolores Catalá, and Mark Hallett. 1997. Functional relevance of cross-modal plasticity in blind humans. Nature 389: 180–83.
Critchley, Macdonald. 1951. Types of visual perseveration: “paliopsia” and “illusory visual spread.” Brain 74: 267–98.
———. 1953. The Parietal Lobes. New York: Hafner.
———. 1962. Dr. Samuel Johnson’s aphasia. Medical History 6: 27–44.
Damasio, Antonio R. 2005. A mechanism for impaired fear recognition after amygdala damage. Nature 433 (7021): 22–23.
Damasio, Antonio R., and Hanna Damasio. 1983. The anatomic basis of pure alexia. Neurology 33: 1573–83.
Damasio, Antonio, Hanna Damasio, and Gary W. Van Hoesen. 1982. Prosopagnosia: Anatomic basis and behavioral mechanisms. Neurology 32: 331.
Darwin, Charles. 1887. The Autobiography of Charles Darwin, 1809–1882. Reprint, New York: W. W. Norton, 1993.
Dehaene, Stanislas. 1999. The Number Sense. New York: Oxford University Press.
———. 2009. Reading in the Brain: The Science and Evolution of a Human Invention. New York: Viking.
Déjerine, J. 1892. Contribution à l’étude anatomo-pathologique et clinique des différentes variétés de cécité verbale. Mémoires de la Société de Biology 4: 61–90.
Della Sala, Sergio, and Andrew W. Young. 2003. Quaglino’s 1867 case of prosopagnosia. Cortex 39: 533–40.
Devinsky, Orrin. 2009. Delusional misidentifications and duplications. Neurology 72: 80–87.
Devinsky, Orrin, Lila Davachi, Cornelia Santchi, Brian T. Quinn, Bernhard P. Staresina, and Thomas Thesen. 2010. Hyperfamiliarity for faces. Neurology 74: 970–74.
Devinsky, Orrin, Martha J. Farah, and William B. Barr. 2008. Visual agnosia. In Handbook of Clinical Neurology, ed. Georg Goldenberg and Bruce Miller, vol. 88: 417–27.
Donald, Merlin. 1991. Origins of the Modern Mind: Three Stages in the Evolution of Culture and Cognition. Cambridge: Harvard University Press.
Duchaine, Bradley, Laura Germine, and Ken Nakayama. 2007. Family resemblance: Ten family members with prosopagnosia and within-class object agnosia. Cognitive Neuropsychology 24 (4): 419–30.
Duchaine, Bradley, and Ken Nakayama. 2005. Dissociations of face and object recognition in developmental prosopagnosia. Journal of Cognitive Neuroscience 172: 249–61.
Eling, Paul, ed. 1994. Reader in the History of Aphasia: From Franz Gall to Norman Geschwind. Philadelphia: John Benjamins.
Ellinwood, Everett H., Jr. 1969. Perception of faces: disorders in organic and psychopathological states. Psychiatric Quarterly 43 (4): 622–46.
Ellis, Hadyn D., and Melanie Florence. 1990. Bodamer’s (1947) paper on prosopagnosia. Cognitive Neuropsychology 7 (2): 81–105.
Engel, Howard. 2005. Memory Book. Toronto: Penguin Canada.
———. 2007. The Man Who Forgot How to Read. Toronto: HarperCollins.
Etcoff, Nancy, Paul Ekman, John J. Magee, and Mark G. Frank. 2000. Lie detection and language comprehension. Nature 405: 139.
Farah, Martha. 2004. Visual Agnosia, 2nd ed. Cambridge: MIT Press/Bradford Books.
Farah, Martha, Michael J. Soso, and Richard M. Dasheiff. 1992. Visual angle of the mind’s eye before and after unilateral occipital lobectomy. Journal of Experimental Psychology: Human Perception and Performance 18 (1): 241–46.
ffytche, D. H., R. J. Howard, M. J. Brammer, A. David, P. Woodruff, and S. Williams. 1998. The anatomy of conscious vision: an fMRI study of visual hallucinations. Nature Neuroscience 1 (8): 738–42.
ffytche, D. H., J. M. Lappin, and M. Philpot. 2004. Visual command hallucinations in a patient with pure alexia. Journal of Neurology, Neurosurgery and Psychiatry 75: 80–86.
Fleishman, John A., John D. Segall, and Frank P. Judge, Jr. 1983. Isolated transient alexia: A migrainous accompaniment. Archives of Neurology 40: 115–16.
Fraser, J. T. 1987. Time, the Familiar Stranger. Amherst: University of Massachusetts Press. (See also Foreword to the 1989 Braille edition, Stuart, FL: Triformation Braille Service.)
Freiwald, Winrich A., Doris Y. Tsao, and Margaret S. Livingstone. 2009. A face feature space in the macaque temporal lobe. Nature Neuroscience 12 (9): 1187–96.
Galton, Francis. 1883. Inquiries into Human Faculty and Its Development. London: Macmillan.
Garrido, Lucia, Nicholas Furl, Bogdan Draganski, Nikolaus Weiskopf, John Stevens, Geoffrey Chern-Yee Tan, Jon Driver, Ray J. Dolan, and Bradley Duchaine. 2009. Voxel-based morphometry reveals reduced grey matter volume in the temporal cortex of developmental prosopagnosics. Brain 132: 3443–55.
Gauthier, Isabel, Pawel Skudlarski, John C. Gore, and Adam W. Anderson. 2000. Expertise for cars and birds recruits brain areas involved in face recognition. Nature Neuroscience 3 (2): 191–97.
Gauthier, Isabel, Michael J. Tarr, and Daniel Bub, eds. 2010. Perceptual Expertise: Bridging Brain and Behavior. New York: Oxford University Press.
Gibson, James J. 1950. The Perception of the Visual World. Boston: Houghton Mifflin.
Goldberg, Elkhonon. 1989. Gradiential approach to neocortical functional organization. Journal of Clinical and Experimental Neuropsychology 11 (4): 489–517.
———. 2009. The New Executive Brain: Frontal Lobes in a Complex World. New York: Oxford University Press.
Gould, Stephen Jay. 1980. The Panda’s Thumb. New York: W. W. Norton.
Grandin, Temple. 1996. Thinking in Pictures: And Other Reports from My Life with Autism. New York: Vintage.
Gregory, R. L. 1980. Perceptions as hypotheses. Philosophical Transactions of the Royal Society, London B 290: 181–97.
Gross, C. G. 1999. Brain, Vision, Memory: Tales in the History of Neuroscience. Cambridge: MIT Press/Bradford Books.
———. 2010. Making sense of printed symbols. Science 327: 524–25.
Gross, C. G., D. B. Bender, C. E. Rocha-Miranda. 1969. Visual receptive fields of neurons in inferotemporal cortex of the monkey. Science 166: 1303–6.
Gross, C. G., C. E. Rocha-Miranda, and D. B. Bender. 1972. Visual properties of neurons in inferotemporal cortex of the macaque. Journal of Neurophysiology 35: 96–111.
Hadamard, Jacques. 1954. The Psychology of Invention in the Mathematical Field. New York: Dover.
Hale, Sheila. 2007. The Man Who Lost His Language: A Case of Aphasia. London and Philadelphia: Jessica Kingsley.
Hamblyn, Richard. 2001. The Invention of Clouds: How an Amateur Meteorologist Forged the Language of the Skies. New York: Farrar, Straus and Giroux.
Harrington, Anne. 1987. Medicine, Mind, and the Double Brain: A Study in Nineteenth-Century Thought. Princeton: Princeton University Press.
Head, Henry. 1926. Aphasia and Kindred Disorders of Speech. 2 vols. Cambridge: Cambridge University Press.
Head, Henry, and Gordon Holmes. 1911. Sensory disturbances from cerebral lesions. Brain 34: 102–254.
Hefter, Rebecca L., Dara S. Manoach, and Jason J. S. Barton. 2005. Perception of facial expression and facial identity in subjects with social developmental disorders. Neurology 65: 1620–25.
Holmes, Oliver Wendell. 1861. Sun painting and sun sculpture. Atlantic Monthly 8: 13–29.
Hubel, David H., and Torsten N. Wiesel. 2005. Brain and Visual Perception: The Story of a 25-Year Collaboration. New York: Oxford University Press.
Hull, John. 1991. Touching the Rock: An Experience of Blindness. New York: Pantheon.
Humphreys, Glyn W., ed. 1999. Case Studies in the Neuropsychology of Vision. East Sussex: Psychology Press.
Judd, Tedd, Howard Gardner, and Norman Geschwind. 1983. Alexia without agraphia in a composer. Brain 106: 435–57.
Julesz, Bela. 1971. Foundations of Cyclopean Perception. Chicago: University of Chicago Press.
Kanwisher, Nancy, Josh McDermott, and Marvin M. Chun. 1997. The fusiform face area: a module in human extrastriate cortex specialized for face perception. Journal of Neuroscience 17 (11): 4302–11.
Kapur, Narinder, ed. 1997. Injured Brains of Medical Minds: Views from Within. Oxford: Oxford University Press.
Karinthy, Frigyes. 2008. Journey Round My Skull. New York: NYRB Classics.
Kelly, David, Paul C. Quinn, Alan M. Slater, Kang Lee, Alan Gibson, Michael Smith, Liezhong Ge, and Olivier Pascalis. 2005. Three-month-olds, but not newborns, prefer own-race faces. Developmental Science 8 (6): F31–F36.
Klessinger, Nicolai, Marcin Szczerbinski, and Rosemary Varley. 2007. Algebra in a man with severe aphasia. Neuropsychologia 45 (8): 1642–48.
Kosslyn, Stephen Michael. 1973. Scanning visual images: Some structural implications. Perception & Psychophysics 14 (1): 90–94.
———. 1980. Image and Mind. Cambridge: Harvard University Press.
Kosslyn, Stephen M., William L. Thompson, and Giorgio Ganis. 2006. The Case for Mental Imagery. New York: Oxford University Press.
Lissauer, Heinrich. 1890. Ein Fall von Seelenblindheit nebst einem Beitrag zur Theorie derselben. Archiv für Psychiatrie 21: 222–70.
Livingstone, Margaret S., and Bevil R. Conway. 2004. Was Rembrandt stereoblind? New England Journal of Medicine 351 (12): 1264–65.
Luria, A. R. 1972. The Man With a Shattered World. New York: Basic Books.
Lusseyran, Jacques. 1998. And There Was Light. New York: Parabola Books.
Magee, Bryan, and Martin Milligan. 1995. On Blindness. New York: Oxford University Press.
Mayer, Eugene, and Bruno Rossion. 2007. Prosopagnosia. In The Behavioral and Cognitive Neurology of Stroke, ed. O. Godefroy and J. Bogousslavsky, pp. 316–35. Cambridge: Cambridge University Press.
McDonald, Ian. 2006. Musical alexia with recovery: A personal account. Brain 129 (10): 2554–61.
McGinn, Colin. 2004. Mindsight: Image, Dream, Meaning. Cambridge: Harvard University Press.
Merabet, L. B., R. Hamilton, G. Schlaug, J. D. Swisher, E. T. Kiriakopoulos, N. B. Pitskel, T. Kauffman, and A. Pascual-Leone. 2008. Rapid and reversible recruitment of early visual cortex for touch. PLoS One Aug. 27: 3 (8): e3046.
Mesulam, M.-M. 1985. Principles of Behavioral Neurology. Philadelphia: F. A. Davis.
Morgan, W. Pringle. 1896. A case of congenital word blindness. British Medical Journal 2 (1871): 1378.
Moss, C. Scott. 1972. Recovery with Aphasia: The Aftermath of My Stroke. Urbana: University of Illinois Press.
Nakayama, Ken. 2001. Modularity in perception, its relation to cognition and knowledge. In Blackwell Handbook of Perception, ed. E. Bruce Goldstein, pp. 737–59. Malden, MA:Wiley- Blackwell.
Ostrovsky, Yuri, Aaron Andalman, and Pawan Sinha. 2006. Vision following extended congenital blindness. Psychological Science 17 (12): 1009–14.
Pallis, C. A. 1955. Impaired identification of faces and places with agnosia for colours. Journal of Neurology, Neurosurgery and Psychiatry 18: 218.
Pammer, Kristen, Peter C. Hansen, Morten L. Kringelbach, Ian Holliday, Gareth Barnes, Arjan Hillebrand, Krish D. Singh, and Piers L. Cornelissen. 2004. Visual word recognition: the first half second. NeuroImage 22: 1819–25.
Pascalis, O., L. S. Scott, D. J. Kelly, R. W. Shannon, E. Nicholson, M. Coleman, and C. A. Nelson. 2005. Plasticity of face processing in infancy. Proceedings of the National Academy of Sciences 102 (14): 5297–5300.
Pascual-Leone, A., L. B. Merabet, D. Maguire, A. Warde, K. Alterescu, and R. Stickgold. 2004. Visual hallucinations during prolonged blindfolding in sighted subjects. Journal of Neuroophthalmology 24 (2): 109–13.
Petersen, S. E., P. T. Fox, M. I. Posner, M. Mintun, and M. E. Raichle. 1988. Positron emission tomographic studies of the cortical anatomy of single-word processing. Nature 331 (6137): 585–89.
Poe, Edgar Allan. 1846. “The Sphinx.” In Complete Stories and Poems of Edgar Allan Poe. Reprint, New York: Doubleday, 1984.
Pomeranz, Howard D., and Simmons Lessell. 2000. Palinopsia and polyopia in the absence of drugs or cerebral disease. Neurology 54: 855–59.
Pons, Tim. 1996. Novel sensations in the congenitally blind. Nature 380: 479–80.
Prescott, William. 1843. A History of the Conquest of Mexico: With a Preliminary View of the Ancient Mexican Civilization and the Life of Hernando Cortes. Reprint, London: Everyman’s Library, 1957.
———. 1847. A History of the Conquest of Peru. Reprint, London: Everyman’s Library, 1934.
Ptito, Maurice, Solvej M. Moesgaard, Albert Gjedde, and Ron Kupers. 2005. Cross-modal plasticity revealed by electrotactile stimulation of the tongue in the congenitally blind. Brain 128 (3): 606–14.
Purves, Dale, and R. Beau Lotto. 2003. Why We See What We Do: An Empirical Theory of Vision. Sunderland, MA: Sinauer Associates.
Quian Quiroga, Rodrigo, Alexander Kraskov, Christof Koch, and Itzhak Fried. 2009. Explicit encoding of multimodal percepts by single neurons in the human brain. Current Biology 19: 1308–13.
Quian Quiroga, R., L. Reddy, G. Kreiman, C. Koch, and I. Fried. 2005. Invariant visual representation by single neurons in the human brain. Nature 435 (23): 1102–07.
Ramachandran, V. S. 1995. Perceptual correlates of neural plasticity in the adult human brain. In Early Vision and Beyond, ed. Thomas V. Papathomas, pp. 227–47. Cambridge: MIT Press/Bradford Books.
———. 2003. Foreword. In Filling-In: From Perceptual Completion to Cortical Reorganization, ed. Luiz Pessoa and Peter De Weerd, pp. xi–xxii. New York: Oxford University Press.
Ramachandran, V. S., and R. L. Gregory. 1991. Perceptual filling in of artificially induced scotomas in human vision. Nature 350 (6320): 699–702.
Renier, Laurent, and Anne G. De Volder. 2005. Cognitive and brain mechanisms in sensory substitution of vision: a contribution to the study of human perception. Journal of Integrative Neuroscience 4 (4): 489–503.
Rocke, Alan J. 2010. Image and Reality: Kekulé, Kopp, and the Scientific Imagination. Chicago: University of Chicago Press.
Romano, Paul. 2003. A case of acute loss of binocular vision and stereoscopic depth perception. Binocular Vision & Strabismus Quarterly 18 (1): 51–55.
Rosenfield, Israel. 1988. The Invention of Memory. New York: Basic Books.
Russell, R., B. Duchaine, and K. Nakayama. 2009. Superrecognizers: People with extraordinary face recognition ability. Psychonomic Bulletin & Review 16: 252–57.
Sacks, Oliver. 1984. A Leg to Stand On. New York: Summit Books.
———. 1985. The Man Who Mistook His Wife for a Hat. New York: Summit Books.
———. 1995. An Anthropologist on Mars. New York: Alfred A. Knopf.
———.1996. The Island of the Colorblind. New York: Alfred A. Knopf.
———. 2006. Stereo Sue. The New Yorker (June 19): 64–73.
———. 2008. Musicophilia. Rev. ed. New York: Alfred A. Knopf.
Sacks, Oliver, and Ralph M. Siegel. 2006. Seeing is believing as brain reveals its adaptability. Letter to the Editor. Nature 441 (7097): 1048.
Sadato, Norihiro. 2005. How the blind “see” Braille: Lessons from functional magnetic resonance imaging. Neuroscientist 11 (6): 577–82.
Sadato, Norihiro, Alvaro Pascual-Leone, Jordan Grafman, Vicente Ibañez, Marie-Pierre Deiber, George Dold, and Mark Hallett. 1996. Activation of the primary visual cortex by Braille reading in blind subjects. Nature 380: 526–28.
Sasaki, Yuka, and Takeo Watanabe. 2004. The primary visual cortex fills in color. Proceedings of the National Academy of Sciences of the USA 101 (52): 18251–56.
Scribner, Charles, Jr. 1993. In the Web of Ideas: The Education of a Publisher. New York: Charles Scribner’s Sons.
Sellers, Heather. 2007. Tell me again who you are. In Best Creative Nonfiction, ed. Lee Gutkind, pp. 281–319. New York: W. W. Norton.
———. 2010. You Don’t Look Like Anyone I Know. New York: Riverhead Books.
Shallice, Tim. 1988. Lissauer on agnosia. Cognitive Neuropsychology 5 (2): 153–92.
Shepard, R. N., and J. Metzler. 1971. Mental rotation of three-dimensional objects. Science 171: 701–03.
Shimojo, Shinsuke, and Ken Nakayama. 1990. Real world occlusion constraints and binocular rivalry. Vision Research 30 (1): 69–80.
Shimojo, S., M. Paradiso, and I. Fujita. 2001. What visual perception tells us about mind and brain. Proceedings of the National Academy of Sciences of the USA 98 (22): 12340–41.
Shimojo, S., and Ladan Shams. 2001. Sensory modalities are not separate modalities: Plasticity and interactions. Current Opinion in Neurobiology 11: 505–09.
Shin, Yong-Wook, Myung Hyon Na, Tae Hyon Ha, Do-Hyung Kang, So-Young Yoo, and Jun Soo Kwon. 2008. Dysfunction in configural face processing in patients with schizophrenia. Schizophrenia Bulletin 34 (3): 538–43.
Sugita, Yoichi. 2008. Face perception in monkeys reared with no exposure to faces. Proceedings of the National Academy of Sciences of the USA 105(1): 394–98.
Tanaka, Keiji. 1996. Inferotemporal cortex and object vision. Annual Review of Neuroscience 19: 109–39.
———. 2003. Columns for complex visual object features in the inferotemporal cortex: Clustering of cells with similar but slightly different stimulus selectivities. Cerebral Cortex 13 (1): 90–99.
Tarr, M. J., and I. Gauthier. 2000. FFA: A flexible fusiform area for subordinate-level visual processing automatized by expertise. Nature Neuroscience 3 (8): 764–69.
Temple, Christine. 1992. Developmental memory impairment: Faces and patterns. In Mental Lives: Case Studies in Cognition, ed. Ruth Campbell, pp. 199–215. Oxford: Blackwell.
Tenberken, Sabriye. 2003. My Path Leads to Tibet. New York: Arcade Publishing.
Torey, Zoltan. 1999. The Crucible of Consciousness. New York: Oxford University Press.
———.2003. Out of Darkness. New York: Picador.
Turnbull, Colin M. 1961. The Forest People. New York: Simon & Schuster.
West, Thomas G. 1997. In the Mind’s Eye: Visual Thinkers, Gifted People with Dyslexia and Other Learning Difficulties, Computer Images and the Ironies of Creativity. Amherst, NY: Prometheus Books.
Wheatstone, Charles. 1838. Contributions to the physiology of vision.—Part the first. On some remarkable, and hitherto unobserved phenomena of binocular vision. Philosophical Transactions of the Royal Society of London 128: 371–94.
Wigan, A. L. 1844. The Duality of the Mind, Proved by the Structure, Functions and Diseases of the Brain. London: Longman, Brown, Green and Longmans.
Wolf, Maryanne. 2007. Proust and the Squid: The Story and Science of the Reading Brain. New York: HarperCollins.
Yardley, Lucy, Lisa McDermott, Stephanie Pisarski, Brad Duchaine, and Ken Nakayama. 2008. Psychosocial consequences of developmental prosopagnosia: A problem of recognition. Journal of Psychosomatic Research 65: 445–51.
Zur, Dror, and Shimon Ullmann. 2003. Filling-in of retinal scotomas. Vision Research 43: 971–82.
ENDNOTES
Sight Reading
1. I saw Dr. P. in 1978, ten years before Benson and his colleagues described PCA. I was puzzled by the picture Dr. P. presented, the paradoxes of his illness. Clearly, he had a degenerative brain disease, yet it seemed quite different from any form of Alzheimer’s disease I had seen. But if not Alzheimer’s, then what did he have? When I read about PCA in 1988—Dr. P. had died in the meantime—I wondered whether this could have been his diagnosis.
PCA, however, is only an anatomical diagnosis; it denotes the part of the brain affected most but says nothing of the underlying disease process, nothing of why these parts of the brain are damaged
When Benson described PCA, he had no information regarding its underlying pathology. His patients might have Alzheimer’s disease, he thought, but if so, it was Alzheimer’s with a strikingly atypical presentation. They might have Pick’s disease, a degenerative brain disorder more commonly affecting the frontal and temporal lobes of the brain. They might even, Benson speculated, have vascular rather than degenerative disease, an accumulation of small blockages in the watershed zone between the posterior and carotid circulations of the brain.
2. I was reminded, when Lilian told me this, of a patient I had seen in the hospital some years before, who had overnight become totally paralyzed from a spinal cord infection, a fulminating myelitis. When it became evident that no recovery was forthcoming, she fell into despair, felt that her life was over—not only the great things of life but the little familiar pleasures of each day, like doing the New York Times crossword, to which she was addicted. She requested that the Times be brought to her each day, so that at least she could look at the puzzle, get its configuration, run her eyes along the clues. But when she did this something extraordinary happened, for as she looked at the clues, the answers seemed to write themselves in their spaces. Her visual imagery strengthened over the next few weeks, until she found that she was able to hold the entire crossword and its clues in her mind after a single, intense inspection, and then solve it, mentally, at her leisure later in the day. This became a source of great solace to her, in her paralysis; she had had no idea, she later told me, that such powers of memory and imagery were available to her.
3. McDonald also lost, temporarily, the ability to play the piano accurately and expressively, a problem Lilian did not have.
Recalled to Life
1. Macdonald Critchley described how Dr. Samuel Johnson lost all ability to speak when he suffered a stroke at the age of seventy-three. “In the middle of the night,” Critchley wrote, “he awoke and immediately realized that he had sustained a stroke.” To satisfy himself that he was not losing his sanity, Johnson composed a Latin prayer in his mind, but found he could not say it aloud. The next morning, June 17, 1783, he gave his servant a note he had been able to write for his next-door neighbor:
Dear Sir, It hath pleased almighty God this morning to deprive me of the powers of speech; and, as I do not know that it may be his farther good pleasure to deprive me soon of my senses, I request you will, on the receipt of this note, come to me, and act for me, as the exigencies of my case may require.
Johnson continued writing letters, with his accustomed richness and magniloquence, over the next few weeks, while he slowly recovered the ability to speak. In some of the letters, though, he made uncharacteristic mistakes, sometimes omitting a word or writing the wrong word; he then corrected his mistakes upon rereading.
2. This was very much the case with Sir John Hale, the distinguished historian, who had a stroke that left him with expressive aphasia. His wife, Sheila Hale, in her book The Man Who Lost His Language, provides a vivid and moving account of her husband’s aphasia, so devastating at first, and how he was able, partly through the power of expert and continuing therapy, to recover, even years later, much of what had seemed irreparably lost. And she brings out how even medical professionals may dismiss aphasic patients as “incurable” or treat them as idiots, despite their manifest intelligence.
3. “The President’s Speech,” a chapter in The Man Who Mistook His Wife for a Hat.
4. Some of Wilkens’s extraordinary therapeutic powers may have gone with the fact that she herself was quadriplegic (having broken her neck in a car accident at the age of eighteen) but nevertheless led an extremely full life and was deeply interested in other people. Seeing the fortitude and resilience of a therapist in some ways even more disabled than themselves inspired Wilkens’s patients to work harder for her, and for themselves.
5. I have written more extensively about music therapy for aphasia in a chapter of Musicophilia.
A Man of Letters
1. This was published as a chapter in An Anthropologist on Mars.
2. Lilian Kallir, too, had alexia sine agraphia, and continued to write letters to her friends around the world. But since her alexia for words developed slowly, over the course of years, she seemed to have insensibly accommodated to the fact that reading and writing could be dissociated in this way.
3. The current term, “visual agnosia,” was introduced by Sigmund Freud the following year.
4. Congenital “word blindness” (which we now call dyslexia) was recognized by neurologists in the 1880s, around the same time that Charcot, Déjerine, and others were describing acquired alexia. Children with severe difficulties in reading (sometimes in writing, reading music, or calculating, too) were often seen as retarded, despite clear evidence to the contrary. W. Pringle Morgan, writing in the British Medical Journal in 1896, detailed a careful study of an intelligent and articulate fourteen-year-old boy who had severe difficulties in reading and spelling:
In writing his own name he made a mistake, putting “Precy” for “Percy,” and he did not notice the mistake until his attention was called to it more than once. . . . Words written or printed seem to convey no impression to his mind, and it is only after laboriously spelling them that he is able, by the sounds of the letters, to discover their import. . . . He can only recognize such simple ones as “and,” “the,” “of,” etc. Other words he never seems to remember, no matter how frequently he may have met them. . . . The schoolmaster who has taught him for some years says that he would be the smartest lad in the school if the instruction were entirely oral.
It is now recognized that as much as five to ten percent of the population has dyslexia and that, whether by way of “compensation” or simply because of their different neurological makeup, many dyslexic people have exceptional talents in other areas. These and many other aspects of dyslexia are discussed in depth by Maryanne Wolf in Proust and the Squid: The Story and Science of the Reading Brain, and by Thomas G. West in In the Mind’s Eye.
5. I am quoting here and elsewhere from the translation provided by Israel Rosenfield in his excellent book The Invention of Memory.
6. Israel Rosenfield also remarks that Oscar C.’s central problem was not just in recognizing letters but in perceiving their sequence, and that he had similar problems with numerical notation. Numbers, Rosenfield writes, “are always read the same way in every context. A 3 is three whether it appears in the phrase ‘3 apples’ or ‘a 3 percent discount.’ But . . . the meaning of a number in a multidigit numeral depends on where it is placed.” It is similar with musical notes, whose meaning depends on context and placement.
Words, Rosenfield continues, are similar:
Changing a single letter in a word can alter both its pronunciation and its meaning. Its significance depends on what precedes and what follows. . . . It is the failure to capture this overall organization—in which identical stimuli, letters, are constantly changed in significance—that is characteristic of patients with verbal blindness. They cannot organize the stimuli in a way that makes sense of the symbols.
7. In the few days that he lived after his second stroke, Oscar C. had aphasia as well. He would say one word in place of another or make garbled sounds and had to rely on mime and gesture to communicate. His wife noticed (“with dread”) that he could no longer write. Israel Rosenfield, analyzing Déjerine’s case in The Invention of Memory, suggests that one may have alexia without agraphia—this is relatively common—but not agraphia without alexia. “Agraphia,” Rosenfield writes, “is always associated with an inability to read.” And yet extremely rare cases of isolated agraphia have been reported, and the debate is not yet resolved.
8. Kristen Pammer and her colleagues have also shown, using magnetoencephalography, that the visual word form area does not work in isolation; it is part of a widely distributed cerebral network. Indeed, some areas in the frontal and temporal lobes are activated by words before the visual word form area. They stress that the spread of activation flows in both directions, to and from the visual word form area.
Nonetheless it is possible to separate the act of reading from meaning, as, for example, I do when I read a religious text in Hebrew. I have learned how the words sound, but have little idea of their meaning. Something similar happens with hyperlexic preschool children, usually autistic, who may be able to read an article in the New York Times fluently and correctly but without comprehension.
9. When we met, Scribner gave me a brief memoir he had just dictated, describing his alexia and how he had adapted to it; subsequently he published this as an afterword in his last book, In the Web of Ideas, from which I am quoting here.
10. Brain damage from a stroke, a tumor, or a degenerative disease may produce a lasting alexia, but there can also be a transient alexia, due to a temporary disturbance in the brain’s visual recognition systems, as can happen, for instance, with migraine. (This has been described by Fleishman et al. and Bigley and Sharp, among others.) I had such an experience driving to an appointment one morning, when I suddenly found myself unable to read the names of streets; they seemed to be written in a strange archaic script—Phoenician, perhaps—that I could not decipher. My first thought was of some external change. New York City is a popular location for filming, and the “altered” street signs, I presumed, were part of some elaborate cinematic setup. Then a sort of shimmering or scintillation around the letters gave me a clue—my alexia, I realized, was part of a migraine aura.
Alexia can also occur in conjunction with epilepsy. I recently saw a patient who described how reading (and only reading) triggers her seizures, but their first manifestation is an alexia. The words and letters before her suddenly become unintelligible, and she recognizes this as the prodrome of a seizure, which will follow within seconds. If she is alone, she will lie down and recite the alphabet to herself. On regaining consciousness after a seizure, she has expressive and receptive aphasia—an inability to speak or comprehend speech—for twenty minutes or so.
11. There are some differences, however. As Maryanne Wolf points out, for example, “motoric memory areas are far more activated in reading Chinese than in reading other languages, because that is how Chinese symbols are learned by young readers—by writing, over and over.” And the same reader may use somewhat different neural circuits for reading different languages.
One may sometimes find bilingual people who, following a stroke, lose the ability to read one language but not another. This has been especially studied in Japan, where there are two forms of written language in common use (often both forms are used in the same sentence). Kanji, which has a set of more than three thousand characters, was derived from Chinese ideograms. Kana, a syllabic system that, like an alphabet, can represent any speech sound, has just forty-six symbols. Though kanji and kana are so different, both employ the visual word form area. Functional MRI studies by Nakayama and Dehaene, however, show subtle but significant differences in their representation within this area, and rare cases have been reported of alexia for kanji but not for kana, and vice versa.
12. Wallace expressed it as follows:
Natural selection could only have endowed savage man with a brain a few degrees superior to that of an ape, whereas he actually possesses one very little inferior to that of a philosopher. . . . It seems as if the organ had been prepared in anticipation of the future progress in man, since it contains latent capacities which are useless to him in his earlier condition.
13. Gould provided a marvelous analysis of Wallace’s thinking in his essay “Natural Selection and the Brain,” reprinted in The Panda’s Thumb.
14. The earliest written languages used pictorial or iconic symbols, which became increasingly abstract and simplified. There were thousands of distinct hieroglyphs in Egypt and tens of thousands of ideograms in classical Chinese; reading (and writing) such a language demands a great deal of training and, presumably, the dedication of a larger portion of the visual cortex. This, Dehaene suggests, may be why most human languages have tended to favor alphabetic systems.
And yet there may be certain powers, certain qualities peculiar to ideograms. Jorge Luis Borges, who was well versed in Japanese poetry, spoke of the multiple connotations of kanji ideograms in an interview:
The Japanese have achieved a wise ambiguity in their poetry. And that, I believe, is because of their particular form of writing itself, because of the possibilities that their ideograms present. Each one, according to its features, can have several connotations. Take, for example, the word “gold.” This word represents or suggests autumn, the color of leaves, or the sunset because of its yellow color.
15. Recently, while eating and talking, Howard bit the tip of his tongue by accident, and for a few days it was swollen and painful to move. He said, “It rendered me, for a day or so, illiterate once again.”
The tongue, with its exquisite sensitivity, has an especially large motor and sensory representation in the brain. For this reason, it can be used for a sort of reading, as Howard does. Remarkably, it can also be used for sensory substitution devices that may enable blind people to “see” (see the chapter “The Mind’s Eye”).
Face-Blind
1. This is an exaggeration—I had no trouble recognizing my parents or my brothers, though I was less adept with my huge extended family and completely lost, sometimes, when I saw photographs of them. I had dozens of aunts and uncles, and when I published my memoir Uncle Tungsten, I selected for the hardcover edition a photograph of another uncle, whom I mistakenly identified as Uncle Tungsten. This upset and bewildered his family, who said, “How could you make such a mistake? They look nothing like one another.” (I corrected the error in the paperback edition.)
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